Provider Demographics
NPI:1114676616
Name:JULIA ROSENGREN PSYCHOLOGIST, INC.
Entity Type:Organization
Organization Name:JULIA ROSENGREN PSYCHOLOGIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENGREN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:858-432-3919
Mailing Address - Street 1:5252 BALBOA AVE STE 803
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6920
Mailing Address - Country:US
Mailing Address - Phone:858-432-3919
Mailing Address - Fax:833-439-5561
Practice Address - Street 1:5252 BALBOA AVE STE 803
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6920
Practice Address - Country:US
Practice Address - Phone:858-432-3919
Practice Address - Fax:833-439-5561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty