Provider Demographics
NPI:1225769292
Name:ROSEN, BRYCE JAMES
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:JAMES
Last Name:ROSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7065 OAKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7792
Mailing Address - Country:US
Mailing Address - Phone:561-714-6302
Mailing Address - Fax:
Practice Address - Street 1:3185 BOUTWELL RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH BEACH
Practice Address - State:FL
Practice Address - Zip Code:33461-2610
Practice Address - Country:US
Practice Address - Phone:561-533-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health