Provider Demographics
NPI:1235213240
Name:SERGI, ROSEMARIE GERMAINE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARIE
Middle Name:GERMAINE
Last Name:SERGI
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 1:500 VICTORY RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171
Mailing Address - Country:US
Mailing Address - Phone:617-774-1053
Mailing Address - Fax:617-847-0915
Practice Address - Street 1:500 VICTORY RD
Practice Address - Street 2:SOUTH SHORE MENTAL HEALTH
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171
Practice Address - Country:US
Practice Address - Phone:617-774-1040
Practice Address - Fax:617-847-0915
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1015368104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7001000P04801OtherBCBS