MEDICARE: KATE JEAN ROSSELLO PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY003267	GA

General Provider Information

NPI Number	:	1144502329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE JEAN ROSSELLO PSYD

Provider Business Mailing Address
First Line	:	4225 UNIVERSITY AVE
Second Line	:	SCHUSTERCENTER, THIRD FLOOR
City	:	COLUMBUS
State	:	GA
Zip	:	31907-5679
Country	:	US
Telephone Number	:	706-507-8741
Fax Number	:

Provider Business Practice Location Address
First Line	:	4225 UNIVERSITY AVE
Second Line	:	SCHUSTERCENTER, THIRD FLOOR
City	:	COLUMBUS
State	:	GA
Zip	:	31907-5679
Country	:	US
Telephone Number	:	706-507-8741
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2011
Last Update Date	:	09/14/2011

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