1659749984 NPI number — ROSA FELIX LICSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659749984 NPI number — ROSA FELIX LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FELIX
Provider First Name:
ROSA
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659749984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3297 WASHINGTON ST
Provider Second Line Business Mailing Address:
BROOKSIDE COMMUNITY HEALTH CENTER/BEHAVIORAL HEALTH
Provider Business Mailing Address City Name:
JAMAICA PLAIN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02130-2655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-983-6047
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NEW HEALTH CHARLESTOWN
Provider Second Line Business Practice Location Address:
15 TUFTS STREET, FLOOR 2R WELLNESS CENTER
Provider Business Practice Location Address City Name:
CHARLESTOWN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
857-238-1100
Provider Business Practice Location Address Fax Number:
857-238-1198
Provider Enumeration Date:
09/03/2015

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:  121496 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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