Provider Demographics
NPI:1144632423
Name:DEROSSETT, DONNA GRACE (RCSWI)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:GRACE
Last Name:DEROSSETT
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 ROCKLEDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2491
Mailing Address - Country:US
Mailing Address - Phone:321-213-2088
Mailing Address - Fax:
Practice Address - Street 1:1282 ROCKLEDGE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2491
Practice Address - Country:US
Practice Address - Phone:321-213-2088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health