Provider Demographics
NPI:1487715520
Name:FERNANDES, ANN MARIE ROSSETTIE (LICSW)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE ROSSETTIE
Last Name:FERNANDES
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 1:317 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1115
Mailing Address - Country:US
Mailing Address - Phone:508-872-1010
Mailing Address - Fax:
Practice Address - Street 1:317 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1115
Practice Address - Country:US
Practice Address - Phone:508-872-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1110581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303287Medicaid
MAM18633OtherBCBC
MA703136OtherTUFTS
MA042611055OtherTAX ID
MA042611055OtherTAX ID
MA1004745OtherNHP
MANP01332OtherBMC