Provider Demographics
NPI:1295441442
Name:WILLIAMS, ROSERESE MARIE
Entity type:Individual
Prefix:
First Name:ROSERESE
Middle Name:MARIE
Last Name:WILLIAMS
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 1:7921 MENTOR AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5637
Mailing Address - Country:US
Mailing Address - Phone:440-497-2657
Mailing Address - Fax:
Practice Address - Street 1:800 OAK ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-4337
Practice Address - Country:US
Practice Address - Phone:440-205-2706
Practice Address - Fax:440-354-2291
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH183216101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor