Provider Demographics
NPI:1114677119
Name:ROSE, ELIZABETH OCONNELL
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:OCONNELL
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 GIBBS STREET
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726
Mailing Address - Country:US
Mailing Address - Phone:774-644-4088
Mailing Address - Fax:
Practice Address - Street 1:1 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-2530
Practice Address - Country:US
Practice Address - Phone:508-772-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician