Provider Demographics
NPI:1699809277
Name:LAURENTI, ROSALIE (MED)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:
Last Name:LAURENTI
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:ROSALIE
Other - Middle Name:
Other - Last Name:LAURENTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:8035 HOSBROOK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2951
Mailing Address - Country:US
Mailing Address - Phone:513-791-5990
Mailing Address - Fax:513-792-3308
Practice Address - Street 1:8035 HOSBROOK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2951
Practice Address - Country:US
Practice Address - Phone:513-791-5990
Practice Address - Fax:513-792-3308
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC5660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPR9303841Medicare ID - Type Unspecified