Provider Demographics
NPI:1699287664
Name:ROSSELLI, JENNIFER EVELYN (MA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EVELYN
Last Name:ROSSELLI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LINWOOD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5612
Mailing Address - Country:US
Mailing Address - Phone:978-502-1626
Mailing Address - Fax:
Practice Address - Street 1:339 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-6718
Practice Address - Country:US
Practice Address - Phone:339-368-7696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health