Provider Demographics
NPI:1225025877
Name:PAOLINI, ROSEMARIE (NP)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:PAOLINI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 OAK ST
Mailing Address - Street 2:SUITE 105W
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1168
Mailing Address - Country:US
Mailing Address - Phone:508-427-3668
Mailing Address - Fax:508-427-2610
Practice Address - Street 1:830 OAK ST
Practice Address - Street 2:SUITE 105W
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1168
Practice Address - Country:US
Practice Address - Phone:508-427-3668
Practice Address - Fax:508-427-2610
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA172783363LA2200X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0308391Medicaid
MA8303879OtherEVERCARE
MA616882OtherTUFTS
MA28308OtherHEALTHNET
MAPN0871OtherBLUE CROSS
P00287209Medicare PIN
MA8303879OtherEVERCARE
MAPN0871OtherBLUE CROSS