Provider Demographics
NPI:1659749984
Name:FELIX, ROSA (LICSW)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:FELIX
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 1:3297 WASHINGTON ST
Mailing Address - Street 2:BROOKSIDE COMMUNITY HEALTH CENTER/BEHAVIORAL HEALTH
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2655
Mailing Address - Country:US
Mailing Address - Phone:617-983-6047
Mailing Address - Fax:
Practice Address - Street 1:NEW HEALTH CHARLESTOWN
Practice Address - Street 2:15 TUFTS STREET, FLOOR 2R WELLNESS CENTER
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129
Practice Address - Country:US
Practice Address - Phone:857-238-1100
Practice Address - Fax:857-238-1198
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1214961041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical