Provider Demographics
NPI:1912943689
Name:ROSEN, KIMBERLY M (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:M
Last Name:ROSEN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 BOYLSTON ST
Mailing Address - Street 2:SUITE 803D
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3608
Mailing Address - Country:US
Mailing Address - Phone:617-423-2244
Mailing Address - Fax:617-423-2244
Practice Address - Street 1:581 BOYLSTON ST
Practice Address - Street 2:SUITE 803D
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3608
Practice Address - Country:US
Practice Address - Phone:617-423-2244
Practice Address - Fax:617-423-2244
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10197291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22164Medicare ID - Type UnspecifiedMEDICARE