Provider Demographics
NPI:1871061267
Name:ROSSI, NICOLE MASTIN
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MASTIN
Last Name:ROSSI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:MASTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8201 FEATHERHILL RD APT 303
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9197
Mailing Address - Country:US
Mailing Address - Phone:607-382-8659
Mailing Address - Fax:
Practice Address - Street 1:1301 CONTINENTAL DR STE 101
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2338
Practice Address - Country:US
Practice Address - Phone:667-600-3396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional