Provider Demographics
NPI:1861617094
Name:ROSENBERG, SAUL E (PHD)
Entity type:Individual
Prefix:DR
First Name:SAUL
Middle Name:E
Last Name:ROSENBERG
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 1:40 CORTE CAYUGA
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1308
Mailing Address - Country:US
Mailing Address - Phone:415-925-3086
Mailing Address - Fax:
Practice Address - Street 1:40 CORTE CAYUGA
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1308
Practice Address - Country:US
Practice Address - Phone:415-925-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5596103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY5596OtherCALIF LIC