Provider Demographics
NPI:1417935487
Name:ROSELL, LUIS BENJAMIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:BENJAMIN
Last Name:ROSELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E MONROE ST
Mailing Address - Street 2:#109
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-1911
Mailing Address - Country:US
Mailing Address - Phone:319-385-8868
Mailing Address - Fax:319-385-8868
Practice Address - Street 1:114 E MONROE ST
Practice Address - Street 2:#109
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-1911
Practice Address - Country:US
Practice Address - Phone:319-385-8868
Practice Address - Fax:319-385-8868
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00897103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical