Provider Demographics
NPI:1124490412
Name:ROSILLO, MARIA OLIVIA SR (LMFT)
Entity type:Individual
Prefix:
First Name:MARIA OLIVIA
Middle Name:
Last Name:ROSILLO
Suffix:SR
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:MARIA OLIVIA
Other - Middle Name:
Other - Last Name:ROSILLO
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:3033 PLAZA ANITA
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1624
Mailing Address - Country:US
Mailing Address - Phone:619-987-3828
Mailing Address - Fax:619-475-6742
Practice Address - Street 1:3033 PLAZA ANITA
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1624
Practice Address - Country:US
Practice Address - Phone:619-987-3828
Practice Address - Fax:619-475-6742
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83797106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist