Provider Demographics
NPI:1245668789
Name:ROSATI, JILLIAN (PSYD)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:ROSATI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 S MAIN ST STE 214
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2126
Mailing Address - Country:US
Mailing Address - Phone:248-977-0524
Mailing Address - Fax:
Practice Address - Street 1:321 S MAIN ST STE 214
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2126
Practice Address - Country:US
Practice Address - Phone:248-977-0524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00603500103TC0700X
NY022859-1103TC0700X
MI6301018848103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical