Active NPI
Ira J Rosen, PH D
- Psychologist
- Lewiston, ME
National Provider Identifier
1407957640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS206
- Practice address
- 443 Main St
Lewiston, ME 04240-6733 - Phone
- (207) 786-0270
- Fax
- (207) 783-0500
- NPI assigned
- Sep 26, 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS206 | ME | Primary |
Addresses
Primary practice location
443 Main St
Lewiston, ME 04240-6733
Mailing address
443 Main St
Lewiston, ME 04240-6733
Phone (207) 786-0270
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003382 | Other | ME | ANTHEM BCBS |
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS206 | ME | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407957640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "443 MAIN ST",
"city": "LEWISTON",
"state": "ME",
"postal_code": "042406733",
"telephone_number": "207-786-0270",
"fax_number": "207-783-0500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "443 MAIN ST",
"city": "LEWISTON",
"state": "ME",
"postal_code": "042406733",
"telephone_number": "207-786-0270",
"fax_number": "207-783-0500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSEN",
"first_name": "IRA",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "PH D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "ME",
"license": "PS206",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "003382",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lewiston, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.