Provider Demographics
NPI:1104259704
Name:ROSAS, CASSANDRA LAUREN (MED)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LAUREN
Last Name:ROSAS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 VAIRO BLVD
Mailing Address - Street 2:29A
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1655
Mailing Address - Country:US
Mailing Address - Phone:248-505-4152
Mailing Address - Fax:
Practice Address - Street 1:190 MATCH FACTORY PL
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-1367
Practice Address - Country:US
Practice Address - Phone:814-355-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health