Provider Demographics
NPI:1639775760
Name:DR. LAUREN ROSSO, PLLC
Entity type:Organization
Organization Name:DR. LAUREN ROSSO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:479-601-2302
Mailing Address - Street 1:1132 N OAK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-1618
Mailing Address - Country:US
Mailing Address - Phone:479-601-2302
Mailing Address - Fax:
Practice Address - Street 1:19 E MOUNTAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-6067
Practice Address - Country:US
Practice Address - Phone:479-308-8530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health