Provider Demographics
NPI:1134171861
Name:ROSENHEIM, HAROLD D (PHD LAC)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:D
Last Name:ROSENHEIM
Suffix:
Gender:M
Credentials:PHD LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 9 1/2 ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-1302
Mailing Address - Country:US
Mailing Address - Phone:701-239-3700
Mailing Address - Fax:701-271-2969
Practice Address - Street 1:VA MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102
Practice Address - Country:US
Practice Address - Phone:701-239-3700
Practice Address - Fax:701-271-2969
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1239101YA0400X
ND124103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1239OtherADDICTION COUNSELING LIC.
ND124OtherPSYCHOLOGY LICENSE
ND25273OtherHEALTH SERVICES REGISTER