Provider Demographics
NPI:1063602472
Name:VASCONCELLOS, ROSA MARCIA (PHD)
Entity type:Individual
Prefix:
First Name:ROSA MARCIA
Middle Name:
Last Name:VASCONCELLOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6146 CAMINO VERDE DR
Mailing Address - Street 2:SUITE P
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1460
Mailing Address - Country:US
Mailing Address - Phone:408-981-6204
Mailing Address - Fax:
Practice Address - Street 1:6146 CAMINO VERDE DR
Practice Address - Street 2:SUITE P
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1460
Practice Address - Country:US
Practice Address - Phone:408-981-6204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22341103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical