Provider Demographics
NPI:1396938338
Name:ROSE-WATTS, SUSAN (MSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ROSE-WATTS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-7738
Mailing Address - Country:US
Mailing Address - Phone:401-732-4838
Mailing Address - Fax:401-276-4111
Practice Address - Street 1:43 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-7738
Practice Address - Country:US
Practice Address - Phone:401-732-4838
Practice Address - Fax:401-726-4111
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30343OtherBLUE CROSS CRISIS