Basic Information
| Provider Information | |||||||||
| NPI: | 1538148648 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSENBAUM | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 WISSAHICKON AVE | ||||||||
| Address2: | SUITE 118 BOX 110 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191444248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152980417 | ||||||||
| FaxNumber: | 2152980502 | ||||||||
| Practice Location | |||||||||
| Address1: | 4333 KELLY DR | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191291760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158432580 | ||||||||
| FaxNumber: | 2158434086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 02/21/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PS008962L | PA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.