Provider Demographics
NPI:1790040046
Name:ROSENBERG, AMY BETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:BETH
Last Name:ROSENBERG
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 1:485 UNDERHILL BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3434
Mailing Address - Country:US
Mailing Address - Phone:516-350-8766
Mailing Address - Fax:
Practice Address - Street 1:485 UNDERHILL BLVD STE 109
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3434
Practice Address - Country:US
Practice Address - Phone:516-350-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019598103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist