Provider Demographics
NPI:1447600861
Name:ROSECRANS, NICOLE (LMHC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ROSECRANS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:NIK
Other - Middle Name:
Other - Last Name:ROSECRANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:431 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-5476
Mailing Address - Country:US
Mailing Address - Phone:617-863-0645
Mailing Address - Fax:
Practice Address - Street 1:431 RIVER ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5476
Practice Address - Country:US
Practice Address - Phone:617-863-0645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MA10670101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator