Provider Demographics
NPI:1194322347
Name:BLOMGREN, ROSE EVA-MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:EVA-MARIE
Last Name:BLOMGREN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:BRIMFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01010-0393
Mailing Address - Country:US
Mailing Address - Phone:413-563-2070
Mailing Address - Fax:
Practice Address - Street 1:1000 WILBRAHAM RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-2050
Practice Address - Country:US
Practice Address - Phone:413-782-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical