Healthcare Provider Details

I. General information

NPI: 1336297639
Provider Name (Legal Business Name): PETER RAYMOND ROSSI JR. M.S., LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SALT POND RD SOUTH KINGSTOWN OFFICE PARK, H6
WAKEFIELD RI
02879-4314
US

IV. Provider business mailing address

24 SALT POND RD SOUTH KINGSTOWN OFFICE PARK, H6
WAKEFIELD RI
02879-4314
US

V. Phone/Fax

Practice location:
  • Phone: 401-782-2886
  • Fax: 401-782-2886
Mailing address:
  • Phone: 401-782-2886
  • Fax: 401-782-2886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000101
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001053
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: