Provider Demographics
NPI:1861421463
Name:ROSENBLUTH, SUSAN CAROL (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CAROL
Last Name:ROSENBLUTH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:930 N DOHENY DR
Mailing Address - Street 2:#307
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3172
Mailing Address - Country:US
Mailing Address - Phone:310-888-8749
Mailing Address - Fax:310-388-5238
Practice Address - Street 1:930 N DOHENY DR
Practice Address - Street 2:#307
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3172
Practice Address - Country:US
Practice Address - Phone:310-888-8749
Practice Address - Fax:310-388-5238
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20139103TC0700X
NY011986103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011986OtherCLINICAL PSYCHOLOGY
CAPSY 20139OtherLICENSE IN CLINICAL PSYCH