Healthcare Provider Details

I. General information

NPI: 1649134685
Provider Name (Legal Business Name): ANGELA JEAN ROSSETTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 W CHANDLER BLVD
CHANDLER AZ
85225-2548
US

IV. Provider business mailing address

1313 S VAL VISTA DR APT 160
MESA AZ
85204-6476
US

V. Phone/Fax

Practice location:
  • Phone: 480-745-0136
  • Fax:
Mailing address:
  • Phone: 586-291-5374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: