Provider Demographics
NPI:1457461352
Name:COLOMBO, ROSELYN E (PHD)
Entity Type:Individual
Prefix:MS
First Name:ROSELYN
Middle Name:E
Last Name:COLOMBO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ROSELYN
Other - Middle Name:E
Other - Last Name:COLOMBO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:375 REDONDO AVE # 442
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-2656
Mailing Address - Country:US
Mailing Address - Phone:714-469-7030
Mailing Address - Fax:
Practice Address - Street 1:250 W 1ST ST
Practice Address - Street 2:SUITE 352
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4736
Practice Address - Country:US
Practice Address - Phone:909-626-8006
Practice Address - Fax:990-624-2137
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9056103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical