Provider Demographics
NPI:1316490758
Name:THOMAS, ROSA MARIA (MA LLP)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:MRS
Other - First Name:ROSA
Other - Middle Name:MARIA
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LLP
Mailing Address - Street 1:873 JORDAN LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1476
Mailing Address - Country:US
Mailing Address - Phone:586-662-5539
Mailing Address - Fax:
Practice Address - Street 1:873 JORDAN LN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1476
Practice Address - Country:US
Practice Address - Phone:586-662-5539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008188103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service