Provider Demographics
NPI:1164800538
Name:ROSELLI, MATTHEW ANTHONY (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ANTHONY
Last Name:ROSELLI
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 Y ST STE 2700
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2309
Mailing Address - Country:US
Mailing Address - Phone:916-734-7246
Mailing Address - Fax:
Practice Address - Street 1:4860 Y ST STE 2700
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2309
Practice Address - Country:US
Practice Address - Phone:916-734-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1189731041C0700X
CA857341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical