Provider Demographics
NPI:1679507842
Name:ROSSI, SHELLEY ELIZABETH (MA)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ELIZABETH
Last Name:ROSSI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 BONNIE CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-6992
Mailing Address - Country:US
Mailing Address - Phone:951-280-0205
Mailing Address - Fax:
Practice Address - Street 1:342 BONNIE CIR
Practice Address - Street 2:SUITE A
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-6992
Practice Address - Country:US
Practice Address - Phone:951-280-0205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34474106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist