Provider Demographics
NPI:1215079488
Name:PHILLIPS, ROSANNE
Entity type:Individual
Prefix:
First Name:ROSANNE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ESSEX GREEN DR
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2927
Mailing Address - Country:US
Mailing Address - Phone:978-532-5444
Mailing Address - Fax:978-532-6366
Practice Address - Street 1:3 ESSEX GREEN DR
Practice Address - Street 2:SUITE ONE
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2927
Practice Address - Country:US
Practice Address - Phone:978-532-5444
Practice Address - Fax:978-532-6366
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1043601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical