Healthcare Provider Details

I. General information

NPI: 1740119627
Provider Name (Legal Business Name): LETICIA ESTHER ROSADO RUSSELL PH.D., ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 MAIN ST STE 107
SAINT HELENA CA
94574-1940
US

IV. Provider business mailing address

184 WHITE COTTAGE RD N
ANGWIN CA
94508-9611
US

V. Phone/Fax

Practice location:
  • Phone: 707-320-8737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number24-104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: