Provider Demographics
NPI:1487690152
Name:ROSE, DEBRA S (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:S
Last Name:ROSE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40A SAINT PAUL ST
Mailing Address - Street 2:UNIT #1
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6502
Mailing Address - Country:US
Mailing Address - Phone:617-232-0513
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKLINE PL
Practice Address - Street 2:SUITE 426
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7224
Practice Address - Country:US
Practice Address - Phone:617-719-9987
Practice Address - Fax:661-773-1506
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1063871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA006557OtherVALUE OPTIONS
MAPO6031OtherBCBS
MA1853953Medicaid
MA90217752OtherUBH
MAPO6031OtherBCBS