| Doctor Name: | DR. TERESA MARIE ROSETTI |
| NPI Number: | 1487087623 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD |
| License Number: | 6301015307 |
| Business Practice Address: | 208 W Dl Ingram Ave 27 Somdg Cannon Afb, NM - 881035014 |
| Business Phone Number: | 5757841104 |
| Business Fax Number: | |
| Mailing Address: | 2402 E Llano Estacado Blvd, CLOVIS |
| State: | NM |
| Postal Code: | 881013975 |
| Phone Number: | 5184234165 |
| Fax Number: | |
| NPI Enumeration Date: | 08/12/2013 |
| NPI Last Update Date: | 09/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 6301015307 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |