Provider Demographics
NPI:1578627691
Name:ROSEMAN, RENA L (LICSW)
Entity Type:Individual
Prefix:MS
First Name:RENA
Middle Name:L
Last Name:ROSEMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:RENA
Other - Middle Name:L
Other - Last Name:BEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6207
Mailing Address - Country:US
Mailing Address - Phone:978-373-1126
Mailing Address - Fax:978-373-6363
Practice Address - Street 1:60 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6207
Practice Address - Country:US
Practice Address - Phone:978-373-1126
Practice Address - Fax:978-373-6363
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA102424101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1312294Medicaid
HEP10093Medicare UPIN
P05429Medicare ID - Type Unspecified