Provider Demographics
NPI:1518308030
Name:MEDEIROS, ROSA M
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:M
Last Name:MEDEIROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:
Other - Last Name:MEDEIROS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADCI
Mailing Address - Street 1:768 NEW PLAINVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1415
Mailing Address - Country:US
Mailing Address - Phone:508-415-3178
Mailing Address - Fax:
Practice Address - Street 1:506 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3509
Practice Address - Country:US
Practice Address - Phone:508-679-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1807101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)