Provider Demographics
NPI:1780867218
Name:ROSEMAN, PETER ALAN (LTD LIC PSYCHOLOGI)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:ALAN
Last Name:ROSEMAN
Suffix:
Gender:M
Credentials:LTD LIC PSYCHOLOGI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1047
Mailing Address - Country:US
Mailing Address - Phone:248-684-6400
Mailing Address - Fax:248-684-6400
Practice Address - Street 1:1800 N MILFORD RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1047
Practice Address - Country:US
Practice Address - Phone:248-684-6400
Practice Address - Fax:248-684-6400
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005111103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical