Provider Demographics
NPI:1871651596
Name:ROSOFF ENCARNACION, MARIAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:
Last Name:ROSOFF ENCARNACION
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MARIAN
Other - Middle Name:R
Other - Last Name:ENCARNACION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:21 FRANKLIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4951
Mailing Address - Country:US
Mailing Address - Phone:617-472-1414
Mailing Address - Fax:617-472-9494
Practice Address - Street 1:21 FRANKLIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4951
Practice Address - Country:US
Practice Address - Phone:617-472-1414
Practice Address - Fax:617-472-9494
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6379103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1063670OtherBEACON HEALTH
MAW10458OtherBCBS MA
MA329777OtherHARVARD PILGRIM HC
MA733054OtherTUFTS HP
MA329777OtherHARVARD PILGRIM HC