Provider Demographics
NPI:1013212935
Name:ROSMARK PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:ROSMARK PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:978-646-8830
Mailing Address - Street 1:85 CONSTITUTION LN
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3694
Mailing Address - Country:US
Mailing Address - Phone:978-646-8830
Mailing Address - Fax:978-646-8862
Practice Address - Street 1:85 CONSTITUTION LN
Practice Address - Street 2:SUITE 2G
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3694
Practice Address - Country:US
Practice Address - Phone:978-646-8830
Practice Address - Fax:978-646-8862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA020679Medicaid
MAW06489OtherBCBS