Provider Demographics
NPI:1952475865
Name:ROSENBERG, LEIGH SCOTT (PSY D)
Entity Type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:SCOTT
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W CITRUS ST
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2502
Mailing Address - Country:US
Mailing Address - Phone:407-682-6330
Mailing Address - Fax:407-682-5972
Practice Address - Street 1:108 W CITRUS ST
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2502
Practice Address - Country:US
Practice Address - Phone:407-682-6330
Practice Address - Fax:407-682-5972
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003608103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73654AMedicare ID - Type Unspecified