Provider Demographics
NPI:1760762942
Name:BIONDO, ROSEMARI A (MA)
Entity Type:Individual
Prefix:
First Name:ROSEMARI
Middle Name:A
Last Name:BIONDO
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 1:336 S MAIN ST
Mailing Address - Street 2:STE 103
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6702
Mailing Address - Country:US
Mailing Address - Phone:248-705-9263
Mailing Address - Fax:888-475-4093
Practice Address - Street 1:336 S MAIN ST
Practice Address - Street 2:STE 103
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-6702
Practice Address - Country:US
Practice Address - Phone:248-705-9263
Practice Address - Fax:888-475-4093
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008520101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional