Provider Demographics
NPI:1376288183
Name:ROSEN, YEHUDIS (MS ED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:YEHUDIS
Middle Name:
Last Name:ROSEN
Suffix:
Gender:F
Credentials:MS ED, BCBA
Other - Prefix:MRS
Other - First Name:YEHUDIS
Other - Middle Name:
Other - Last Name:RUBANOWITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS ED , BCBA
Mailing Address - Street 1:5587 SHAUN RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1619
Mailing Address - Country:US
Mailing Address - Phone:248-880-5945
Mailing Address - Fax:
Practice Address - Street 1:5587 SHAUN RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-1619
Practice Address - Country:US
Practice Address - Phone:248-880-5945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-22-59089103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst