Provider Demographics
NPI:1982883518
Name:ROSSELL, LAURAJENN (MASTERS EDUCATION)
Entity type:Individual
Prefix:MRS
First Name:LAURAJENN
Middle Name:
Last Name:ROSSELL
Suffix:
Gender:F
Credentials:MASTERS EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15333-2114
Mailing Address - Country:US
Mailing Address - Phone:724-632-6801
Mailing Address - Fax:724-632-6312
Practice Address - Street 1:1070 OLD NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:PA
Practice Address - Zip Code:15333-2114
Practice Address - Country:US
Practice Address - Phone:724-632-6801
Practice Address - Fax:724-632-6312
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007288440037Medicaid
PA1007288440087Medicaid
PA328834A776089OtherVALUE BEHAVIOR HEALTH
PA1007288440030Medicaid
PA328834A336347OtherVALUE BEHAVIORAL HEALTH
PA1007288440027Medicaid