MEDICARE: ERIN ROSSELLO MA

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

General Provider Information

NPI Number	:	1922400423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN ROSSELLO MA

Provider Business Mailing Address
First Line	:	1949 1/2 WESTWOOD BLVD
Second Line	:	SUITE 7
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-8414
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1949 1/2 WESTWOOD BLVD
Second Line	:	SUITE 7
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-8414
Country	:	US
Telephone Number	:	310-625-7155
Fax Number	:

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

Provider Enumeration Date	:	09/16/2014
Last Update Date	:	09/16/2014

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