Provider Demographics
NPI:1902044910
Name:DR ROSA CENTER FOR MENTAL HEALTH PA
Entity Type:Organization
Organization Name:DR ROSA CENTER FOR MENTAL HEALTH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:MM,MPH
Authorized Official - Phone:954-757-7672
Mailing Address - Street 1:5451 N UNIVERSITY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4641
Mailing Address - Country:US
Mailing Address - Phone:954-757-7672
Mailing Address - Fax:954-757-7670
Practice Address - Street 1:5451 N UNIVERSITY DR STE 102
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4641
Practice Address - Country:US
Practice Address - Phone:954-757-7672
Practice Address - Fax:954-757-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME716172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41672FMedicare UPIN