Provider Demographics
NPI:1508830910
Name:ROSENBAUM, MICHAEL S (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13610 CAMBRIA BAY LN
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-5660
Mailing Address - Country:US
Mailing Address - Phone:251-554-4927
Mailing Address - Fax:561-359-2836
Practice Address - Street 1:13610 CAMBRIA BAY LN
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-5660
Practice Address - Country:US
Practice Address - Phone:251-344-1482
Practice Address - Fax:561-359-2836
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10113103TC0700X
AL330103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R35722Medicare UPIN