Provider Demographics
NPI:1235382649
Name:JOHNSON, ROSA ARELIS (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:ARELIS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:A
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:44 LANTERN LN
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1127
Mailing Address - Country:US
Mailing Address - Phone:774-259-8610
Mailing Address - Fax:
Practice Address - Street 1:940 BELMONT ST BLDG 3
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5596
Practice Address - Country:US
Practice Address - Phone:774-259-8610
Practice Address - Fax:617-232-0078
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1176091041C0700X
MA20304201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical