Provider Demographics
NPI:1871873554
Name:ROSELLI, RICHARD (LCSW)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:ROSELLI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 N CONGRESS AVE APT 32
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8644
Mailing Address - Country:US
Mailing Address - Phone:703-634-3080
Mailing Address - Fax:703-997-7220
Practice Address - Street 1:10306 EATON PL STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2201
Practice Address - Country:US
Practice Address - Phone:703-634-3080
Practice Address - Fax:703-997-7220
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040080471041C0700X
FLSW184041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical