MEDICARE: DR. STEPHANIE ROSSO PHD

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	103TC2200X	Clinical Child & Adolescent Psychologist	PSY 19711	CA

General Provider Information

NPI Number	:	1619022266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE ROSSO PHD

Provider Business Mailing Address
First Line	:	5737 THORNHILL DR
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-2144
Country	:	US
Telephone Number	:	650-814-8818
Fax Number	:

Provider Business Practice Location Address
First Line	:	5737 THORNHILL DR
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-2144
Country	:	US
Telephone Number	:	650-814-8818
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	02/18/2026

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