MEDICARE: MATTHEW R ROZZI 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	103TC1900X	Counseling Psychologist	3994-57	WI
2	103T00000X	Psychologist	3994-57	WI

General Provider Information

NPI Number	:	1679236137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW R ROZZI PHD

Provider Business Mailing Address
First Line	:	3902 MILWAUKEE ST UNIT 7002
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53707-5002
Country	:	US
Telephone Number	:	608-602-8883
Fax Number	:

Provider Business Practice Location Address
First Line	:	3902 MILWAUKEE ST UNIT 7002
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53707-5002
Country	:	US
Telephone Number	:	608-602-8883
Fax Number	:

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

Provider Enumeration Date	:	10/20/2021
Last Update Date	:	01/12/2024

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