Provider Demographics
NPI:1033444963
Name:ROSELLI, RICHARD (LICSW, LMFT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:ROSELLI
Suffix:
Gender:M
Credentials:LICSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 MORRIS RD SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-6312
Mailing Address - Country:US
Mailing Address - Phone:202-715-1610
Mailing Address - Fax:202-610-7348
Practice Address - Street 1:1604 MORRIS RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6312
Practice Address - Country:US
Practice Address - Phone:202-715-1610
Practice Address - Fax:202-610-7348
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500788161041C0700X
DCLMFT000056106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist