Provider Demographics
NPI:1275735656
Name:ROSIN, JACOB C (M A LLP)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:C
Last Name:ROSIN
Suffix:
Gender:M
Credentials:M A LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E 11 MILE RD APT 20
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2746
Mailing Address - Country:US
Mailing Address - Phone:248-514-6887
Mailing Address - Fax:
Practice Address - Street 1:409 PLYMOUTH RD STE 140
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1866
Practice Address - Country:US
Practice Address - Phone:248-514-6887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361002793103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical