Healthcare Provider Details

I. General information

NPI: 1063135796
Provider Name (Legal Business Name): ROSEMAN MEDICAL RESEARCH INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BREAKTHROUGH WAY
LAS VEGAS NV
89135-3011
US

IV. Provider business mailing address

10530 DISCOVERY DR
LAS VEGAS NV
89135-3050
US

V. Phone/Fax

Practice location:
  • Phone: 702-802-2851
  • Fax:
Mailing address:
  • Phone: 702-802-2878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA LEE CONNOLLY
Title or Position: SR. EXE DEAN, FINANCE & OPERATION
Credential:
Phone: 702-802-2878