Provider Demographics
NPI:1598959546
Name:ROSEBORO, ERICA LATOYA (MSN)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:LATOYA
Last Name:ROSEBORO
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1906
Mailing Address - Country:US
Mailing Address - Phone:508-854-3320
Mailing Address - Fax:508-753-5051
Practice Address - Street 1:105 MERRICK ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1937
Practice Address - Country:US
Practice Address - Phone:508-797-6100
Practice Address - Fax:508-797-0693
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1306421Medicaid
MAM18684OtherBCBS MH
MA1308785Medicaid
MA2220002001OtherBCBS
MAY10400OtherMEDICARE GROUP NUMBER