Provider Demographics
NPI:1467283812
Name:ROSENFELD, MARY ANN (PSY,D)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:ROSENFELD
Suffix:
Gender:F
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 1:20 SEA COLONY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5321
Mailing Address - Country:US
Mailing Address - Phone:310-396-8266
Mailing Address - Fax:
Practice Address - Street 1:170 S CANYON VIEW DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-3808
Practice Address - Country:US
Practice Address - Phone:310-396-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16321103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty