Provider Demographics
NPI:1154429454
Name:ROZELLE, DEBORAH (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:ROZELLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WATERMAN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4313
Mailing Address - Country:US
Mailing Address - Phone:781-862-4800
Mailing Address - Fax:401-252-4203
Practice Address - Street 1:205 WATERMAN ST STE 105
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4313
Practice Address - Country:US
Practice Address - Phone:781-862-4800
Practice Address - Fax:401-252-4203
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3728101YM0800X
MA7589103TC0700X, 103TC2200X
RIPS01896103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1154429454-7698OtherBCBS OF RI
MAROW50673Medicare ID - Type Unspecified