Provider Demographics
NPI:1497952196
Name:ROSSE, WILLIAM (PSYCH ASSIST INTERN)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:ROSSE
Suffix:
Gender:M
Credentials:PSYCH ASSIST INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7261
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95061-7261
Mailing Address - Country:US
Mailing Address - Phone:831-423-9444
Mailing Address - Fax:831-423-1532
Practice Address - Street 1:104 WALNUT AVE
Practice Address - Street 2:STE 208
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3900
Practice Address - Country:US
Practice Address - Phone:831-423-9444
Practice Address - Fax:831-423-1532
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist