Provider Demographics
NPI:1114078367
Name:WETMORE, ROSEMARIE L (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARIE
Middle Name:L
Last Name:WETMORE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 ANDOVER ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5044
Mailing Address - Country:US
Mailing Address - Phone:978-975-2107
Mailing Address - Fax:978-975-2122
Practice Address - Street 1:451 ANDOVER ST
Practice Address - Street 2:SUITE 213
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5044
Practice Address - Country:US
Practice Address - Phone:978-975-2107
Practice Address - Fax:978-975-2122
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1051061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03205Medicare PIN