Provider Demographics
NPI:1457883357
Name:ROSEN, DAVID MICHAEL
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:ROSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PROVIDENCE HWY
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-2624
Mailing Address - Country:US
Mailing Address - Phone:617-600-8509
Mailing Address - Fax:774-628-9657
Practice Address - Street 1:55 PROVIDENCE HWY
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-2624
Practice Address - Country:US
Practice Address - Phone:617-600-8509
Practice Address - Fax:774-628-9657
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health