Provider Demographics
NPI:1346793882
Name:ROSA, LEANDRO
Entity Type:Individual
Prefix:
First Name:LEANDRO
Middle Name:
Last Name:ROSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 NANTASKET AVE APT BSMNT
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:MA
Mailing Address - Zip Code:02045-2111
Mailing Address - Country:US
Mailing Address - Phone:646-554-3817
Mailing Address - Fax:
Practice Address - Street 1:485 NANTASKET AVE UNIT C
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:MA
Practice Address - Zip Code:02045-2556
Practice Address - Country:US
Practice Address - Phone:781-925-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220230104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker