Provider Demographics
NPI:1235205634
Name:ROSIN, CHARLES A (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:ROSIN
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 1:205 DAL RICH VILLAGE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080
Mailing Address - Country:US
Mailing Address - Phone:972-437-0531
Mailing Address - Fax:972-233-2966
Practice Address - Street 1:205 DAL RICH VILLAGE
Practice Address - Street 2:SUITE 205
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080
Practice Address - Country:US
Practice Address - Phone:972-437-0531
Practice Address - Fax:972-233-2966
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2 1567103T00000X
TX21567103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112564OtherMEDICARE
TXPOODEM792Medicaid