MEDICARE: MR. PETER RAYMOND ROSSI JR. M.S., LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	000101	RI
2	106H00000X	Marriage & Family Therapist	001053	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27753-0	OTHER	RI	BCBSRI PROVIDER #
2	PR62742	OTHER	RI	RI MED ASSISTANCE #
3	1037320	OTHER	RI	BEACON-NEIGHBORHOOD #
4	411768	OTHER	RI	BCBSRI - BLUE CHIP #

General Provider Information

NPI Number	:	1336297639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER RAYMOND ROSSI JR. M.S., LMFT

Provider Business Mailing Address
First Line	:	24 SALT POND RD
Second Line	:	SOUTH KINGSTOWN OFFICE PARK, H6
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-4314
Country	:	US
Telephone Number	:	401-782-2886
Fax Number	:	401-782-2886

Provider Business Practice Location Address
First Line	:	24 SALT POND RD
Second Line	:	SOUTH KINGSTOWN OFFICE PARK, H6
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-4314
Country	:	US
Telephone Number	:	401-782-2886
Fax Number	:	401-782-2886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. PETER RAYMOND ROSSI JR. M.S., LMFT” Practice Location

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