Provider Demographics
NPI:1841395365
Name:COLLINS MOORES, ROSANNE (LICSW)
Entity Type:Individual
Prefix:
First Name:ROSANNE
Middle Name:
Last Name:COLLINS MOORES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ROSANNE
Other - Middle Name:M
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:1 WEST FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176
Mailing Address - Country:US
Mailing Address - Phone:781-665-0021
Mailing Address - Fax:781-665-0027
Practice Address - Street 1:500 LYNNFIELD ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-1424
Practice Address - Country:US
Practice Address - Phone:781-477-3932
Practice Address - Fax:781-477-3930
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10317181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1891359Medicaid
MA103171OtherTUFTS
P21971Medicare UPIN