Healthcare Provider Details

I. General information

NPI: 1427513183
Provider Name (Legal Business Name): CONSTANCE PATRICIA ROSSELOT LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 SYCAMORE ST
CINCINNATI OH
45202-1305
US

IV. Provider business mailing address

909 SYCAMORE ST
CINCINNATI OH
45202-1305
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-9006
  • Fax: 513-558-3880
Mailing address:
  • Phone: 513-558-9006
  • Fax: 513-558-3880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1440495-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: