Provider Demographics
NPI:1487821203
Name:ROSSMAN, JEFFREY MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:ROSSMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 ROWE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-8902
Mailing Address - Country:US
Mailing Address - Phone:413-528-2146
Mailing Address - Fax:
Practice Address - Street 1:38 ROWE RD
Practice Address - Street 2:
Practice Address - City:EGREMONT
Practice Address - State:MA
Practice Address - Zip Code:01230-8902
Practice Address - Country:US
Practice Address - Phone:413-528-2146
Practice Address - Fax:413-528-2146
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4014103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO4027Medicare PIN