Provider Demographics
NPI:1255495073
Name:ROSENBLUM, REBECCA E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:E
Last Name:ROSENBLUM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3008
Mailing Address - Country:US
Mailing Address - Phone:617-661-1422
Mailing Address - Fax:617-661-3667
Practice Address - Street 1:857 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3008
Practice Address - Country:US
Practice Address - Phone:617-661-1422
Practice Address - Fax:617-661-3667
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7555103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0501743Medicaid
MAW05869OtherBLUE CROSS BLUE SHIELD MA
MAW10461OtherBLUE CROSS BLUE SHIELD MA
MAW10461OtherBLUE CROSS BLUE SHIELD MA