Provider Demographics
NPI:1649489824
Name:MARSILIA, ROSA EVELYN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:EVELYN
Last Name:MARSILIA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:ROSA
Other - Middle Name:EVEYLN
Other - Last Name:MARSILIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:1145 SAGAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5503
Mailing Address - Country:US
Mailing Address - Phone:603-205-6053
Mailing Address - Fax:
Practice Address - Street 1:1145 SAGAMORE AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5585
Practice Address - Country:US
Practice Address - Phone:603-205-6053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1164211041C0700X
NH15531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30428942Medicaid