Provider Demographics
NPI:1508095969
Name:ROSEN, ALISON (BIND PSYCH LMT CMT)
Entity Type:Individual
Prefix:MS
First Name:ALISON
Middle Name:
Last Name:ROSEN
Suffix:
Gender:F
Credentials:BIND PSYCH LMT CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:LAKE HUGHES
Mailing Address - State:CA
Mailing Address - Zip Code:93532-0406
Mailing Address - Country:US
Mailing Address - Phone:661-435-3142
Mailing Address - Fax:267-948-5144
Practice Address - Street 1:42505 RANCH CLUB ROAD
Practice Address - Street 2:LAKE ELIZABETH GOLF AND RANCH CLUB
Practice Address - City:ELIZABETH LAKE
Practice Address - State:CA
Practice Address - Zip Code:93532
Practice Address - Country:US
Practice Address - Phone:661-435-3142
Practice Address - Fax:267-948-5144
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10010915225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist