Basic Information
| Provider Information | |||||||||
| NPI: | 1508201914 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHAEL D. ROSBERG PHD A PSYCHOLOGICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2457 ENDICOTT ST | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900323047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232275252 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23622 CALABASAS RD | ||||||||
| Address2: | SUITE 151 | ||||||||
| City: | CALABASAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913021549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186935830 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2013 | ||||||||
| LastUpdateDate: | 06/09/2014 | ||||||||
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| AuthorizedOfficialLastName: | JACKSON | ||||||||
| AuthorizedOfficialFirstName: | DONETTA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3233182520 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY15355 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.