Doctor Name: | MR. PHILLIP JAY ROSENBAUM |
NPI Number: | 1023313665 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 114 Orchard Lake Rd Pontiac, MI - 483412244 |
Business Phone Number: | 2486243812 |
Business Fax Number: | 2486240368 |
Mailing Address: | 114 Orchard Lake Rd, PONTIAC |
State: | MI |
Postal Code: | 483412244 |
Phone Number: | 2486243812 |
Fax Number: | 2486240368 |
NPI Enumeration Date: | 01/12/2011 |
NPI Last Update Date: | 01/12/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YS0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | School |
Taxonomy Definition: |