Basic Information
Provider Information
NPI: 1003295494
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROSEN
FirstName: HEATHER
MiddleName: RACHEL
NamePrefix: DR.
NameSuffix:  
Credential: PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 725 WELCH RD
Address2:  
City: PALO ALTO
State: CA
PostalCode: 943041601
CountryCode: US
TelephoneNumber: 6504978000
FaxNumber:  
Practice Location
Address1: 401 QUARRY ROAD
Address2:  
City: STANFORD
State: CA
PostalCode: 94305
CountryCode: US
TelephoneNumber: 6507235511
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/19/2015
LastUpdateDate: 07/30/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X30234CAY Behavioral Health & Social Service ProvidersPsychologist 
103T00000X  N Behavioral Health & Social Service ProvidersPsychologist 

No ID Information.


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