Provider Demographics
NPI:1326259581
Name:ROSBERG, TRACY ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ELIZABETH
Last Name:ROSBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23480 PARK SORRENTO STE 200B
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1306
Mailing Address - Country:US
Mailing Address - Phone:818-591-3000
Mailing Address - Fax:
Practice Address - Street 1:23480 PARK SORRENTO STE 200B
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1306
Practice Address - Country:US
Practice Address - Phone:818-591-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16145103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical