Provider Demographics
NPI:1356366595
Name:ROSEN, ANDREW (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:ROSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 LINTON BLVD
Mailing Address - Street 2:#D503
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6584
Mailing Address - Country:US
Mailing Address - Phone:561-496-1094
Mailing Address - Fax:561-496-6511
Practice Address - Street 1:4800 LINTON BLVD
Practice Address - Street 2:#D503
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6584
Practice Address - Country:US
Practice Address - Phone:561-496-1094
Practice Address - Fax:561-496-6511
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3452101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75805Medicare ID - Type UnspecifiedPROVIDER NUMBER