Provider Demographics
NPI:1437341914
Name:ROSENBERG, MERCEDES E (PSYD)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:E
Last Name:ROSENBERG
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 1:11985 BIRD DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3564
Mailing Address - Country:US
Mailing Address - Phone:305-596-3335
Mailing Address - Fax:305-227-1901
Practice Address - Street 1:11110 N KENDALL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-0938
Practice Address - Country:US
Practice Address - Phone:305-596-3335
Practice Address - Fax:305-596-3976
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2022-06-30
Deactivation Date:2022-05-12
Deactivation Code:
Reactivation Date:2022-06-13
Provider Licenses
StateLicense IDTaxonomies
FLPY6349103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL765981400Medicaid