Provider Demographics
NPI:1891990362
Name:ROSEN, FRAYDA ILENE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:FRAYDA
Middle Name:ILENE
Last Name:ROSEN
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 1:1600 WEST UNIVERSITY AVENUE
Mailing Address - Street 2:STE 303
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:651-644-1813
Mailing Address - Fax:651-644-1870
Practice Address - Street 1:1600 WEST UNIVERSITY AVENUE
Practice Address - Street 2:STE 303
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-644-1813
Practice Address - Fax:651-644-1870
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program