Provider Demographics
NPI:1134213903
Name:ALIZA ROSEN, PSY.D.,P.A.
Entity type:Organization
Organization Name:ALIZA ROSEN, PSY.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIZA
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-757-7957
Mailing Address - Street 1:1370 BEDFORD DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1993
Mailing Address - Country:US
Mailing Address - Phone:321-757-7957
Mailing Address - Fax:321-265-4015
Practice Address - Street 1:1370 BEDFORD DR
Practice Address - Street 2:106
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1993
Practice Address - Country:US
Practice Address - Phone:321-757-7957
Practice Address - Fax:321-265-4015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6029103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6992Medicare ID - Type Unspecified