Basic Information
| Provider Information | |||||||||
| NPI: | 1073177911 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSSI | ||||||||
| FirstName: | ROSEMARY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6880 | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875026880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052160332 | ||||||||
| FaxNumber: | 5059820279 | ||||||||
| Practice Location | |||||||||
| Address1: | 649 HARKLE RD STE E | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875054765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059559454 | ||||||||
| FaxNumber: | 5052169067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2019 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 108033 | MA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | SWB-2022-0851 | NM | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.