Provider Demographics
NPI:1033385745
Name:ARENA DEROSA, ARCHNGELINA (DIRECTOR)
Entity Type:Individual
Prefix:MS
First Name:ARCHNGELINA
Middle Name:
Last Name:ARENA DEROSA
Suffix:
Gender:F
Credentials:DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 GOULDING ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-2558
Mailing Address - Country:US
Mailing Address - Phone:508-429-0622
Mailing Address - Fax:508-429-0695
Practice Address - Street 1:150 GOULDING ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-2558
Practice Address - Country:US
Practice Address - Phone:508-429-0622
Practice Address - Fax:508-429-0695
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker