Provider Demographics
NPI:1184706376
Name:ROSEN, ERIC L (PHD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:L
Last Name:ROSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 ALT 19 STE C1
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5361
Mailing Address - Country:US
Mailing Address - Phone:727-787-6177
Mailing Address - Fax:727-787-8406
Practice Address - Street 1:2142 ALT 19 STE C1
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-5361
Practice Address - Country:US
Practice Address - Phone:727-787-6177
Practice Address - Fax:727-787-8406
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0005165103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
59760ZMedicare PIN
FL59760AMedicare ID - Type Unspecified