Provider Demographics
NPI:1033815386
Name:ROSA, NATHALI (LCSW)
Entity Type:Individual
Prefix:
First Name:NATHALI
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 BAIRD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-3623
Mailing Address - Country:US
Mailing Address - Phone:401-548-8861
Mailing Address - Fax:
Practice Address - Street 1:200 MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4119
Practice Address - Country:US
Practice Address - Phone:401-728-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical