Provider Demographics
NPI:1598155038
Name:ROSSI, ANTHONY (PHD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:ROSSI
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 1:410 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2603
Mailing Address - Country:US
Mailing Address - Phone:607-737-1235
Mailing Address - Fax:607-735-9617
Practice Address - Street 1:410 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2603
Practice Address - Country:US
Practice Address - Phone:607-737-1235
Practice Address - Fax:607-735-9617
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012684103T00000X
NH1079103T00000X
CT001507103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist