Provider Demographics
NPI:1497469431
Name:DE LA ROSA, ELYSSIA
Entity Type:Individual
Prefix:
First Name:ELYSSIA
Middle Name:
Last Name:DE LA ROSA
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 1:6 HILLSIDE PL APT 1
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-4802
Mailing Address - Country:US
Mailing Address - Phone:978-872-0238
Mailing Address - Fax:
Practice Address - Street 1:6 HILLSIDE PL APT 1
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-4802
Practice Address - Country:US
Practice Address - Phone:978-872-0238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician