Provider Demographics
NPI:1043485543
Name:C VAN ROSEN PHD PC
Entity type:Organization
Organization Name:C VAN ROSEN PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:C
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:251-621-2990
Mailing Address - Street 1:28980 HWY 98
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-7283
Mailing Address - Country:US
Mailing Address - Phone:251-621-2990
Mailing Address - Fax:251-621-2921
Practice Address - Street 1:28980 HWY 98
Practice Address - Street 2:SUITE 1
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7283
Practice Address - Country:US
Practice Address - Phone:251-621-2990
Practice Address - Fax:251-621-2921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000070686Medicaid
AL51506934OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL000070686Medicare PIN