Provider Demographics
NPI:1396394359
Name:GARY S. ROSE PH.D. LLC
Entity Type:Organization
Organization Name:GARY S. ROSE PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:978-250-8400
Mailing Address - Street 1:7 COACHMEN LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-2027
Mailing Address - Country:US
Mailing Address - Phone:978-250-8400
Mailing Address - Fax:
Practice Address - Street 1:45 WALDEN ST STE 1
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2513
Practice Address - Country:US
Practice Address - Phone:978-250-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty