Provider Demographics
NPI:1457676413
Name:ROOSLET, MARLEY HASSLER (LICSW)
Entity Type:Individual
Prefix:
First Name:MARLEY
Middle Name:HASSLER
Last Name:ROOSLET
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MARLEY
Other - Middle Name:A
Other - Last Name:HASSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:427 COLUMBIA RD STE 113
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-3213
Mailing Address - Country:US
Mailing Address - Phone:781-763-7505
Mailing Address - Fax:
Practice Address - Street 1:427 COLUMBIA RD STE 113
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-3213
Practice Address - Country:US
Practice Address - Phone:781-763-7505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical