Provider Demographics
NPI:1871593038
Name:ROSEN, JAMES W (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:ROSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:600 W GRAND AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-3941
Mailing Address - Country:US
Mailing Address - Phone:501-623-2050
Mailing Address - Fax:501-844-4736
Practice Address - Street 1:600 W GRAND AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-3941
Practice Address - Country:US
Practice Address - Phone:501-623-2050
Practice Address - Fax:501-844-4736
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR80-23P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56397Medicare ID - Type Unspecified