Provider Demographics
NPI:1770524241
Name:ROSEN, DIANNE E (PHD)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:E
Last Name:ROSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 STIRLING RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6565
Mailing Address - Country:US
Mailing Address - Phone:305-935-1364
Mailing Address - Fax:305-935-1439
Practice Address - Street 1:3107 STIRLING RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6565
Practice Address - Country:US
Practice Address - Phone:305-935-1364
Practice Address - Fax:305-935-1439
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2553103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75292Medicare ID - Type Unspecified