Provider Demographics
NPI:1558685909
Name:CARYL H. ROSEN, PH.D. AND ASSOCIATES, INC
Entity Type:Organization
Organization Name:CARYL H. ROSEN, PH.D. AND ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARYL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:219-201-0711
Mailing Address - Street 1:9250 COLUMBIA AVE STE 2F
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3530
Mailing Address - Country:US
Mailing Address - Phone:219-201-0711
Mailing Address - Fax:219-836-6445
Practice Address - Street 1:9250 COLUMBIA AVE STE 2F
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3530
Practice Address - Country:US
Practice Address - Phone:219-201-0711
Practice Address - Fax:219-836-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC0700X
IN99037329A101YP2500X
IL071005821103TC0700X
IN20041300A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL90000882OtherBLUE CROSS BLUE SHIELD OF ILLINOIS