Provider Demographics
NPI:1861569162
Name:ROSENZWEIG, SANFORD (PHD)
Entity type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:
Last Name:ROSENZWEIG
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 1:17 CAMERON RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-3101
Mailing Address - Country:US
Mailing Address - Phone:508-358-5918
Mailing Address - Fax:309-419-7419
Practice Address - Street 1:17 CAMERON RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-3101
Practice Address - Country:US
Practice Address - Phone:508-358-5918
Practice Address - Fax:309-419-7419
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA926103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW01666Medicare ID - Type UnspecifiedLICENSE # 926
MAW01666Medicare ID - Type Unspecified