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General NPI Number Information
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NPI Number | 1639775760
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Entity Type | Organization
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Legal Business Name | DR. LAUREN ROSSO, PLLC
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Dates
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Enumeration Date | 12/04/2020
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 19 E MOUNTAIN ST STE 5
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-6067
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Country | US
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Telephone | 479-308-8530
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Fax |
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Provider Business Mailing Address
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Address Line | 1132 N OAK DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-1618
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Country | US
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Telephone | 479-601-2302
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAUREN ROSSO
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Credential | PSYD
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Telephone | 479-601-2302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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