Provider Demographics
NPI:1922217025
Name:PIETAL, ROSE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:PIETAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WENHAM ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1703
Mailing Address - Country:US
Mailing Address - Phone:978-476-1441
Mailing Address - Fax:978-745-7615
Practice Address - Street 1:33 WENHAM ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1703
Practice Address - Country:US
Practice Address - Phone:978-476-1441
Practice Address - Fax:978-745-7615
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor