Provider Demographics
NPI:1104285717
Name:ROSSITER, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:ROSSITER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 BISHOP ST
Mailing Address - Street 2:UNIT 1, ROOM 4
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2681
Mailing Address - Country:US
Mailing Address - Phone:207-671-7178
Mailing Address - Fax:
Practice Address - Street 1:68 BISHOP ST
Practice Address - Street 2:UNIT 1, ROOM 4
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2681
Practice Address - Country:US
Practice Address - Phone:207-671-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4397101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health