Provider Demographics
NPI:1558452797
Name:ROSSELLO, JEANNETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:
Last Name:ROSSELLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:420 AVE PONCE DE LEON
Mailing Address - Street 2:MIDTOWN BUILDING SUITE 206
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3416
Mailing Address - Country:US
Mailing Address - Phone:787-758-2793
Mailing Address - Fax:787-751-1578
Practice Address - Street 1:420 AVE PONCE DE LEON
Practice Address - Street 2:MIDTOWN BUILDING SUITE 206
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3416
Practice Address - Country:US
Practice Address - Phone:787-758-2793
Practice Address - Fax:787-751-1578
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR440103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical