Provider Demographics
NPI:1295083384
Name:SPOSATO-VILLASMIL, ROSANNA
Entity type:Individual
Prefix:
First Name:ROSANNA
Middle Name:
Last Name:SPOSATO-VILLASMIL
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ROSANNA
Other - Middle Name:
Other - Last Name:SPOSATO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1112 SANDRINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 BALA AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3307
Practice Address - Country:US
Practice Address - Phone:267-939-4216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017181103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical