Provider Demographics
NPI:1336568559
Name:ROSA, DAISY (BA, CAC)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:BA, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1014
Mailing Address - Country:US
Mailing Address - Phone:610-478-0646
Mailing Address - Fax:610-478-1671
Practice Address - Street 1:22 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1014
Practice Address - Country:US
Practice Address - Phone:610-478-0646
Practice Address - Fax:610-478-1671
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)