Provider Demographics
NPI:1225073745
Name:ROSSER, SANDRA S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:S
Last Name:ROSSER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 ANGELL ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4414
Mailing Address - Country:US
Mailing Address - Phone:401-203-3206
Mailing Address - Fax:
Practice Address - Street 1:534 ANGELL ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4414
Practice Address - Country:US
Practice Address - Phone:401-203-3206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8469103TC0700X
RIPS00910103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical