Provider Demographics
NPI:1992702153
Name:ROSETE, PAUL E (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:ROSETE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18587 E CARRIAGE WAY
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-3503
Mailing Address - Country:US
Mailing Address - Phone:480-988-5155
Mailing Address - Fax:480-210-8218
Practice Address - Street 1:1298 E AVENIDA GRANDE
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-1006
Practice Address - Country:US
Practice Address - Phone:480-268-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-02
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-004934103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ407176Medicaid
FL73540OtherBLUE CROSS BLUE SHIELD FL