Provider Demographics
NPI:1427632900
Name:SIGNORELLO, ROSE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:SIGNORELLO
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 1:4621 WAYCROSS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-3723
Mailing Address - Country:US
Mailing Address - Phone:713-824-0897
Mailing Address - Fax:
Practice Address - Street 1:4621 WAYCROSS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-3723
Practice Address - Country:US
Practice Address - Phone:713-824-0897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24834103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist