Provider Demographics
NPI:1396187290
Name:ROSSETTINI, JORDAN (RN, PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:
Last Name:ROSSETTINI
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:GEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:495 WEMPLE RD
Mailing Address - Street 2:
Mailing Address - City:GLENMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12077-4004
Mailing Address - Country:US
Mailing Address - Phone:518-264-1405
Mailing Address - Fax:
Practice Address - Street 1:30 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1410
Practice Address - Country:US
Practice Address - Phone:518-453-6750
Practice Address - Fax:518-453-6785
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF403397363LP0808X
NY673600163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool