Provider Demographics
NPI:1548562804
Name:JACKSON, ROSEMARIE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARIE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NARROWS RD
Mailing Address - Street 2:SUITE C 201
Mailing Address - City:WESTMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01473-1677
Mailing Address - Country:US
Mailing Address - Phone:978-874-5700
Mailing Address - Fax:978-874-5701
Practice Address - Street 1:2 NARROWS RD
Practice Address - Street 2:SUITE C 201
Practice Address - City:WESTMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01473-1677
Practice Address - Country:US
Practice Address - Phone:978-874-5700
Practice Address - Fax:978-874-5701
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1158301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical