Provider Demographics
NPI:1891118030
Name:O'ROSCO, MARLENE
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:
Last Name:O'ROSCO
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 1:1600 E LITTLE CREEK RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-4136
Mailing Address - Country:US
Mailing Address - Phone:757-962-8640
Mailing Address - Fax:757-962-8641
Practice Address - Street 1:1600 E LITTLE CREEK RD
Practice Address - Street 2:SUITE 315
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-4136
Practice Address - Country:US
Practice Address - Phone:757-962-8640
Practice Address - Fax:757-962-8641
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2348101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2348OtherSTATE DBHD LICENSE