Provider Demographics
NPI:1609015098
Name:ROSENSTOCK, AMBER SHAW
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:SHAW
Last Name:ROSENSTOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11980 SAN VICENTE BLVD STE 711
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6605
Mailing Address - Country:US
Mailing Address - Phone:310-949-9267
Mailing Address - Fax:
Practice Address - Street 1:11980 SAN VICENTE BLVD STE 711
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6605
Practice Address - Country:US
Practice Address - Phone:310-949-9267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22454103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist