Provider Demographics
NPI:1992750905
Name:ROSEDALE, BEVERLY A (MS)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:A
Last Name:ROSEDALE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 VARNUM DR
Mailing Address - Street 2:
Mailing Address - City:E GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-2025
Mailing Address - Country:US
Mailing Address - Phone:401-884-1937
Mailing Address - Fax:401-885-7680
Practice Address - Street 1:2905 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-3174
Practice Address - Country:US
Practice Address - Phone:401-732-1999
Practice Address - Fax:401-885-7680
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI0052106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist