Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
Y | 102L00000X | Psychologist | 30234 | CA |
Y | 103T00000X | Psychologist | 30234 | CA |
NPI | 1003295494 |
---|---|
Provider Name | Dr. Heather Rachel Rosen |
First Address | Palo Alto, CA 94304-1601 |
Second Address | Stanford, CA 94305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2015 |
Last Update Date | 30/07/2018 |