1841395365 NPI number — ROSANNE COLLINS MOORES LICSW

Table of content: ROSANNE COLLINS MOORES LICSW (NPI 1841395365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841395365 NPI number — ROSANNE COLLINS MOORES LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS MOORES
Provider First Name:
ROSANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLLINS
Provider Other First Name:
ROSANNE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841395365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 WEST FOSTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELROSE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-665-0021
Provider Business Mailing Address Fax Number:
781-665-0027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 LYNNFIELD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01904-1424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-477-3932
Provider Business Practice Location Address Fax Number:
781-477-3930
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  1031718 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1891359 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103171 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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