Provider Demographics
NPI:1780741033
Name:ROSEN, ADAM P (PHD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:P
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 1:49 HANCOCK ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3188
Mailing Address - Country:US
Mailing Address - Phone:617-921-0332
Mailing Address - Fax:
Practice Address - Street 1:49 HANCOCK ST
Practice Address - Street 2:SUITE 107
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3188
Practice Address - Country:US
Practice Address - Phone:617-921-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7382103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWW3016Medicare ID - Type Unspecified