Provider Demographics
NPI:1003166422
Name:ROSEN, VALERIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:
Last Name:ROSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:ROSEN
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:255 S 17TH ST
Mailing Address - Street 2:SUITE 1307
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6231
Mailing Address - Country:US
Mailing Address - Phone:267-634-1719
Mailing Address - Fax:
Practice Address - Street 1:602 WOODCREST AVE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-1920
Practice Address - Country:US
Practice Address - Phone:267-634-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017255103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical