Provider Demographics
NPI:1740506732
Name:DECROCE, ROSEMARY E (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:E
Last Name:DECROCE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 WAYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4667
Mailing Address - Country:US
Mailing Address - Phone:401-935-7759
Mailing Address - Fax:401-521-0849
Practice Address - Street 1:173 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3919
Practice Address - Country:US
Practice Address - Phone:401-935-7759
Practice Address - Fax:401-521-0849
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPSOO800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical