MEDICARE: DR. LUIS BENJAMIN ROSELL PSY.D

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	103TC0700X	Clinical Psychologist	00897	IA

General Provider Information

NPI Number	:	1417935487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS BENJAMIN ROSELL PSY.D

Provider Business Mailing Address
First Line	:	114 E MONROE ST
Second Line	:	#109
City	:	MT PLEASANT
State	:	IA
Zip	:	52641-1911
Country	:	US
Telephone Number	:	319-385-8868
Fax Number	:	319-385-8868

Provider Business Practice Location Address
First Line	:	114 E MONROE ST
Second Line	:	#109
City	:	MT PLEASANT
State	:	IA
Zip	:	52641-1911
Country	:	US
Telephone Number	:	319-385-8868
Fax Number	:	319-385-8868

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	07/08/2007

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