Provider Demographics
NPI:1497241608
Name:ROSE, MARISSA
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MOSWANSICUT LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-1153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 MOSWANSICUT LAKE DR
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:RI
Practice Address - Zip Code:02857-1153
Practice Address - Country:US
Practice Address - Phone:401-864-0191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor