Provider Demographics
NPI:1730212275
Name:ROSENBERG, MARY LEON (PHD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LEON
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14340 TORREY CHASE BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-1021
Mailing Address - Country:US
Mailing Address - Phone:281-580-8086
Mailing Address - Fax:281-580-7129
Practice Address - Street 1:14340 TORREY CHASE BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1021
Practice Address - Country:US
Practice Address - Phone:281-580-8086
Practice Address - Fax:281-580-7129
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3794103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent