Individual
RAY M ROSENBLOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1114 LOST CREEK BLVD STE 320, AUSTIN, TX 78746
(512) 983-6816
(512) 858-2053
Mailing address
1810 DEERFIELD RD, DRIPPING SPRINGS, TX 78620-4224
(512) 983-6816
(512) 858-2053
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
33167
TX
103TC0700X
Clinical Psychologist
6301002325
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11287287
CAQH
—
01
—
620F34837
BLUE CROSS BLUE SHIELD MI
MI
Enumeration date
12/01/2006
Last updated
08/04/2019
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