Provider Demographics
NPI:1720286057
Name:ROUSSO, JOEL D (BA)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:D
Last Name:ROUSSO
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:JOEL
Other - Middle Name:
Other - Last Name:ROUSSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA PSYCHOLOGY
Mailing Address - Street 1:7171 BOWLING DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2043
Mailing Address - Country:US
Mailing Address - Phone:916-394-9195
Mailing Address - Fax:
Practice Address - Street 1:7171 BOWLING DR STE 300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2043
Practice Address - Country:US
Practice Address - Phone:916-394-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-09
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health