Healthcare Provider Details

I. General information

NPI: 1417935487
Provider Name (Legal Business Name): LUIS BENJAMIN ROSELL PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E MONROE ST #109
MT PLEASANT IA
52641-1911
US

IV. Provider business mailing address

114 E MONROE ST #109
MT PLEASANT IA
52641-1911
US

V. Phone/Fax

Practice location:
  • Phone: 319-385-8868
  • Fax: 319-385-8868
Mailing address:
  • Phone: 319-385-8868
  • Fax: 319-385-8868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number00897
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: