Healthcare Provider Details

I. General information

NPI: 1033444963
Provider Name (Legal Business Name): RICHARD ROSELLI LICSW, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 MORRIS RD SE
WASHINGTON DC
20020-6312
US

IV. Provider business mailing address

1604 MORRIS RD SE
WASHINGTON DC
20020-6312
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-1610
  • Fax: 202-610-7348
Mailing address:
  • Phone: 202-715-1610
  • Fax: 202-610-7348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50078816
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT000056
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: