Provider Demographics
NPI:1679781900
Name:ROSIELLO, FLORENCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:FLORENCE
Middle Name:
Last Name:ROSIELLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 MOONLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-4779
Mailing Address - Country:US
Mailing Address - Phone:646-872-7304
Mailing Address - Fax:
Practice Address - Street 1:151 MOONLIGHT DR
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-4779
Practice Address - Country:US
Practice Address - Phone:646-872-7304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0322761102L00000X
AZ125661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1679781900Medicaid