Provider Demographics
NPI:1346236684
Name:NEGELE, ROSE ANNE (EDD)
Entity type:Individual
Prefix:DR
First Name:ROSE
Middle Name:ANNE
Last Name:NEGELE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BOWDOIN ST
Mailing Address - Street 2:STE 1A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4246
Mailing Address - Country:US
Mailing Address - Phone:617-722-0888
Mailing Address - Fax:617-738-8412
Practice Address - Street 1:13 BOWDOIN ST
Practice Address - Street 2:STE 1A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4246
Practice Address - Country:US
Practice Address - Phone:617-722-0888
Practice Address - Fax:617-738-8412
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1843103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02031Medicare ID - Type Unspecified