Provider Demographics
NPI:1710184536
Name:ROSENFELD, TERRY MARTIN (MA)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:MARTIN
Last Name:ROSENFELD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 WATERFORD RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5430
Mailing Address - Country:US
Mailing Address - Phone:215-702-1378
Mailing Address - Fax:215-702-1379
Practice Address - Street 1:503 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5512
Practice Address - Country:US
Practice Address - Phone:215-497-0240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS000258L103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation