Provider Demographics
NPI:1255121497
Name:ROSER, ANESSA ELAINE
Entity type:Individual
Prefix:
First Name:ANESSA
Middle Name:ELAINE
Last Name:ROSER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SAWMILL DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-4419
Mailing Address - Country:US
Mailing Address - Phone:843-501-6458
Mailing Address - Fax:
Practice Address - Street 1:125 SAWMILL DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-4419
Practice Address - Country:US
Practice Address - Phone:843-501-6458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst