Provider Demographics
NPI:1952960684
Name:ROSANA MARZULLO-DOVE, PSYD, LLC
Entity Type:Organization
Organization Name:ROSANA MARZULLO-DOVE, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARZULLO-DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-613-8587
Mailing Address - Street 1:912 W PLATT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2108
Mailing Address - Country:US
Mailing Address - Phone:813-613-8587
Mailing Address - Fax:
Practice Address - Street 1:912 W PLATT ST STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2108
Practice Address - Country:US
Practice Address - Phone:813-613-8587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health