Provider Demographics
NPI:1114214558
Name:CAVALCANTE, ROSELI (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSELI
Middle Name:
Last Name:CAVALCANTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 GARVER LN
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-3571
Mailing Address - Country:US
Mailing Address - Phone:505-629-5955
Mailing Address - Fax:
Practice Address - Street 1:382 GARVER LN
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3571
Practice Address - Country:US
Practice Address - Phone:505-629-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM330768103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool