Provider Demographics
NPI:1770201873
Name:ROSA, MILLETTE
Entity type:Individual
Prefix:
First Name:MILLETTE
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MILLETTE
Other - Middle Name:
Other - Last Name:ROSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M ED
Mailing Address - Street 1:9 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-1623
Mailing Address - Country:US
Mailing Address - Phone:978-328-9280
Mailing Address - Fax:
Practice Address - Street 1:55 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2007
Practice Address - Country:US
Practice Address - Phone:617-541-1829
Practice Address - Fax:413-238-1549
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)