Provider Demographics
NPI:1144349093
Name:ROSSNER, JEAN (LMHC)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:ROSSNER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 260373
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-0007
Mailing Address - Country:US
Mailing Address - Phone:617-520-4557
Mailing Address - Fax:617-249-1973
Practice Address - Street 1:1452 DORCHESTER AVE
Practice Address - Street 2:FCBL, 4TH FLOOR
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1386
Practice Address - Country:US
Practice Address - Phone:617-520-4557
Practice Address - Fax:617-249-1973
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8038101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health