Provider Demographics
NPI:1477621738
Name:ROSA, DANIEL WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WILLIAM
Last Name:ROSA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:10 ADAMS ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-1746
Mailing Address - Country:US
Mailing Address - Phone:978-251-7887
Mailing Address - Fax:978-251-5196
Practice Address - Street 1:10 ADAMS ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-1746
Practice Address - Country:US
Practice Address - Phone:978-251-7887
Practice Address - Fax:978-251-5196
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA6100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical