Provider Demographics
NPI:1851460968
Name:ROSEN, CARYL H (CARYL HROSEN, PHD)
Entity Type:Individual
Prefix:DR
First Name:CARYL
Middle Name:H
Last Name:ROSEN
Suffix:
Gender:F
Credentials:CARYL HROSEN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 COLUMBIA AVE STE 2F
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3530
Mailing Address - Country:US
Mailing Address - Phone:219-201-0711
Mailing Address - Fax:219-836-6445
Practice Address - Street 1:9250 COLUMBIA AVE STE 2F
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-201-0711
Practice Address - Fax:219-836-6445
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005821103TC0700X
FLPY9548103TC0700X
IN20041300A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634892OtherBLUE CROSS BLUE SHIELD
IN90000882OtherBLUE CROSS BLUE SHIELD OF ILLINOIS