Provider Demographics
NPI:1144345307
Name:ROSAS, GARRETT LEE (PSYD)
Entity type:Individual
Prefix:MR
First Name:GARRETT
Middle Name:LEE
Last Name:ROSAS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NORTH 7TH STREET
Mailing Address - Street 2:ATTN MANAGED CARE
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046
Mailing Address - Country:US
Mailing Address - Phone:717-273-1710
Mailing Address - Fax:717-273-1416
Practice Address - Street 1:334 YORK ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325
Practice Address - Country:US
Practice Address - Phone:717-337-0026
Practice Address - Fax:717-337-1260
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAPS016587103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health