Provider Demographics
NPI:1720475429
Name:ROSENBAUM, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 MERIDIAN AVE PO BOX 26591
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126
Mailing Address - Country:US
Mailing Address - Phone:408-471-9003
Mailing Address - Fax:
Practice Address - Street 1:6155 OAK ST STE E9
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-2240
Practice Address - Country:US
Practice Address - Phone:408-471-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7090101YM0800X
KS02980101YM0800X
MO2020039929101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health