Provider Demographics
NPI:1629179635
Name:ROSENZWEIG, SUSAN G (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:G
Last Name:ROSENZWEIG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2476 NW NORTHRUP ST
Mailing Address - Street 2:# 2B
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3133
Mailing Address - Country:US
Mailing Address - Phone:503-206-8337
Mailing Address - Fax:503-528-8405
Practice Address - Street 1:2476 NW NORTHRUP ST
Practice Address - Street 2:# 2B
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3133
Practice Address - Country:US
Practice Address - Phone:503-206-8337
Practice Address - Fax:503-206-8032
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1222103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R0000TCPFDMedicare ID - Type Unspecified