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General NPI Number Information
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NPI Number | 1992448864
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Entity Type | Individual
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Provider Name | SYDNEY RENEE ROSCOE DNP, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/18/2022
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 501 S 54TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19143-1900
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Country | US
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Telephone | 445-428-5800
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Fax |
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Provider Business Mailing Address
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Address Line | FILE 57326
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City | LOS ANGELES
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State | CA
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Zip | 90074-0001
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Country | US
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Telephone | 858-249-6748
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95221940
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 95027107
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP031429
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License Number State | PA
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