MEDICARE: ANTHONY ROSSI PH.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	103T00000X	Psychologist	012684	NY
2	103T00000X	Psychologist	1079	NH
3	103T00000X	Psychologist	001507	CT

General Provider Information

NPI Number	:	1598155038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY ROSSI PH.D.

Provider Business Mailing Address
First Line	:	410 W CHURCH ST
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-2603
Country	:	US
Telephone Number	:	607-737-1235
Fax Number	:	607-735-9617

Provider Business Practice Location Address
First Line	:	410 W CHURCH ST
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-2603
Country	:	US
Telephone Number	:	607-737-1235
Fax Number	:	607-735-9617

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

Provider Enumeration Date	:	02/04/2015
Last Update Date	:	02/04/2015

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