Healthcare Provider Details

I. General information

NPI: 1497795371
Provider Name (Legal Business Name): KRISTAL LAMB ROSSI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12550 NEW BRITTANY BLVD
FORT MYERS FL
33907-3655
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-936-1114
  • Fax: 239-936-5968
Mailing address:
  • Phone: 239-424-1400
  • Fax: 239-424-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9886
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1846C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: