Provider Demographics
NPI:1073794137
Name:ROSENBERG, JEFFREY I (PHD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:I
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 CONNECTICUT AVE NW STE 223
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3710
Mailing Address - Country:US
Mailing Address - Phone:202-723-2211
Mailing Address - Fax:
Practice Address - Street 1:4501 CONNECTICUT AVE NW STE 223
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-3710
Practice Address - Country:US
Practice Address - Phone:202-723-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1770103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical