Provider Demographics
NPI:1821006446
Name:ROSEN, DEAN LAWRENCE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:LAWRENCE
Last Name:ROSEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8704
Mailing Address - Country:US
Mailing Address - Phone:314-872-0288
Mailing Address - Fax:314-872-3934
Practice Address - Street 1:763 S NEW BALLAS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8704
Practice Address - Country:US
Practice Address - Phone:314-872-0288
Practice Address - Fax:314-872-3934
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00844103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO70032Medicare ID - Type Unspecified
MOR00663Medicare UPIN