Active NPI
Daniel J Rosenbaum, PH.D.
- Clinical Psychologist
- Phoenix, AZ
National Provider Identifier
1154381127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3323
- Practice address
- 1012 E Willetta St
3Rd Floor and 5TH Floor
Phoenix, AZ 85006-2749 - Phone
- (602) 239-2361
- NPI assigned
- Mar 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3323 | AZ | Primary |
Addresses
Primary practice location
1012 E Willetta St
3Rd Floor and 5TH Floor
Phoenix, AZ 85006-2749
Mailing address
1441 N 12TH St
Phoenix, AZ 85006-2837
Phone (602) 495-4577
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 912221 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3323 | AZ | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308700800000",
"number": "1154381127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1441 N 12TH ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850062837",
"telephone_number": "602-495-4577",
"fax_number": "602-417-3549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1012 E WILLETTA ST",
"address_2": "3RD FLOOR AND 5TH FLOOR",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850062749",
"telephone_number": "602-239-2361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSENBAUM",
"first_name": "DANIEL",
"middle_name": "J",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-24",
"last_updated": "2011-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AZ",
"license": "3323",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "912221",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.