Provider Demographics
NPI:1700214202
Name:ROSSI, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ROSSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 ESTUDILLO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4611
Mailing Address - Country:US
Mailing Address - Phone:510-352-0336
Mailing Address - Fax:
Practice Address - Street 1:100 MASONIC AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-4415
Practice Address - Country:US
Practice Address - Phone:415-567-8370
Practice Address - Fax:415-346-2356
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363861041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical