Provider Demographics
NPI:1780887828
Name:ROSEN, ABBY (PHD)
Entity type:Individual
Prefix:DR
First Name:ABBY
Middle Name:
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 1:980 AWALD RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-3631
Mailing Address - Country:US
Mailing Address - Phone:410-267-0280
Mailing Address - Fax:
Practice Address - Street 1:980 AWALD RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-3631
Practice Address - Country:US
Practice Address - Phone:410-269-6298
Practice Address - Fax:410-269-0314
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2156103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG589OtherBLUE CROSSPROVIDER NUMBER
MDG589OtherBLUE CROSSPROVIDER NUMBER