ELLIOTT B ROSENBAUM PSYD PA
Agencies at Baymeadows Rd, Jacksonville, FL

License number
Florida PY8117
Category
Agencies
Type
Community/Behavioral Health
Owner
Name: DR. ELLIOTT ROSENBAUM PSYD
Title: DIRECTOR
Phone: (904) 252-7979
Address
Address
4465 Baymeadows Rd SUITE 7, Jacksonville, FL 32217
National Provider ID: 1912292004
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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ELLIOTT B. ROSENBAUM, PSY.D., PA

Jacksonville, FL

Status:
Inactive
Industry:
Specialty Outpatient Clinic, Medical Doctor's Office
Inactive reason:
ADMIN DISSOLUTION FOR ANNUAL REPORT
Registration:
Jul 20, 2010
Inactive since:
Sep 26, 2014
Addresses:
4465 Baymeadows Rd SUITE # 7, Jacksonville, FL 32217 (Physical)
3113 Cornelia Dr, Jacksonville, FL 32257
State ID:
P10000059642
Business type:
Florida Profit Corporation
President, Secretary, Vice Presidents:
Elliott Bdr. Rosenbaum President, Treasurer, inactive, 4465 Baymeadows Rd #7, Jacksonville, FL 32217 (Physical),Emily Rosenbaum President, Secretary, Vice President, inactive, 4465 Baymeadows Rd #7, Jacksonville, FL 32217 (Physical)
Agent:
Elliott Rosenbaum,4465 Baymeadows Rd #7, Jacksonville, FL 32217 (Physical)
EIN:
273115657

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