Provider Demographics
NPI:1285807677
Name:BERBERT, ROSANGELA BACCIOTTI (MSE, NCC)
Entity type:Individual
Prefix:MRS
First Name:ROSANGELA
Middle Name:BACCIOTTI
Last Name:BERBERT
Suffix:
Gender:F
Credentials:MSE, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 PHEASANT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-6931
Mailing Address - Country:US
Mailing Address - Phone:920-303-1864
Mailing Address - Fax:
Practice Address - Street 1:1478 KENWOOD CTR
Practice Address - Street 2:SUITE # 1
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1161
Practice Address - Country:US
Practice Address - Phone:920-886-9319
Practice Address - Fax:920-886-9357
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4030-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional