Provider Demographics
NPI:1841578358
Name:DE ROSA, ROBIN ELAINE (MPA)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:ELAINE
Last Name:DE ROSA
Suffix:
Gender:F
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2687 NAUTILUS AVE NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-1072
Mailing Address - Country:US
Mailing Address - Phone:702-496-3171
Mailing Address - Fax:
Practice Address - Street 1:2687 NAUTILUS AVE NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-1072
Practice Address - Country:US
Practice Address - Phone:702-496-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor