Provider Demographics
NPI:1609959782
Name:ROSENBERG, LARRY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:M
Last Name:ROSENBERG
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 1:2777 SUMMER ST
Mailing Address - Street 2:SUITE 504B
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-4318
Mailing Address - Country:US
Mailing Address - Phone:203-961-9933
Mailing Address - Fax:203-325-0145
Practice Address - Street 1:2777 SUMMER ST
Practice Address - Street 2:SUITE 504B
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-4318
Practice Address - Country:US
Practice Address - Phone:203-961-9933
Practice Address - Fax:203-325-0145
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001365103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical