Provider Demographics
NPI:1073098059
Name:ROSE, DEBORAH M (LICSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:ROSE
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 1:20 CEREL CIR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-1929
Mailing Address - Country:US
Mailing Address - Phone:508-588-5826
Mailing Address - Fax:
Practice Address - Street 1:20 CEREL CIR
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-1929
Practice Address - Country:US
Practice Address - Phone:617-642-3305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10250151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical