Provider Demographics
NPI:1053321372
Name:QUAGAN, ROSEMARY (LICSW)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:QUAGAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:NEWTON GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28366-0227
Mailing Address - Country:US
Mailing Address - Phone:910-567-6194
Mailing Address - Fax:910-567-5342
Practice Address - Street 1:3331 EASY ST
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-7988
Practice Address - Country:US
Practice Address - Phone:910-567-6194
Practice Address - Fax:508-860-7990
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11613104100000X
NCC0084811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0300010Medicaid
MA97477301OtherNETWORK HEALTH
MA042485308OtherNETWORK HEALTH-GROUP
MA1300709Medicaid
MA56118OtherFALLON
MA1001250OtherBEACON-GROUP
MAOTH000Medicare Oscar/Certification
MAY10141Medicare ID - Type UnspecifiedPART B
MA1001250OtherBEACON-GROUP
MAY10141Medicare ID - Type UnspecifiedPART B-GROUP
MA0300010Medicaid