Provider Demographics
NPI:1336297639
Name:ROSSI, PETER RAYMOND JR (MS, LMFT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:RAYMOND
Last Name:ROSSI
Suffix:JR
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SALT POND RD
Mailing Address - Street 2:SOUTH KINGSTOWN OFFICE PARK, H6
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-4314
Mailing Address - Country:US
Mailing Address - Phone:401-782-2886
Mailing Address - Fax:401-782-2886
Practice Address - Street 1:24 SALT POND RD
Practice Address - Street 2:SOUTH KINGSTOWN OFFICE PARK, H6
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4314
Practice Address - Country:US
Practice Address - Phone:401-782-2886
Practice Address - Fax:401-782-2886
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI000101106H00000X
CT001053106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI27753-0OtherBCBSRI PROVIDER #
RIPR62742OtherRI MED ASSISTANCE #
RI1037320OtherBEACON-NEIGHBORHOOD #
RI411768OtherBCBSRI - BLUE CHIP #