Provider Demographics
NPI:1700619806
Name:ROUSSELO, PATRICIA SUE (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:SUE
Last Name:ROUSSELO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 E DUNBAR RD UNIT 30
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-5032
Mailing Address - Country:US
Mailing Address - Phone:734-735-5175
Mailing Address - Fax:
Practice Address - Street 1:23 W 1ST ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2332
Practice Address - Country:US
Practice Address - Phone:734-639-2262
Practice Address - Fax:734-621-5075
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009181103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical