Provider Demographics
NPI:1851517544
Name:ROSENBERGER, SUSAN RENEA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RENEA
Last Name:ROSENBERGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 MAIN ST
Mailing Address - Street 2:APT. B
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-1822
Mailing Address - Country:US
Mailing Address - Phone:270-761-4442
Mailing Address - Fax:
Practice Address - Street 1:212 WELLS HALL
Practice Address - Street 2:MURRAY STATE UNIVERSITY
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-3318
Practice Address - Country:US
Practice Address - Phone:270-809-2504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2006-101103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical