Healthcare Provider Details

I. General information

NPI: 1922217025
Provider Name (Legal Business Name): ROSE PIETAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 10/03/2020
Certification Date: 10/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 WENHAM ST
DANVERS MA
01923-1703
US

IV. Provider business mailing address

33 WENHAM ST
DANVERS MA
01923-1703
US

V. Phone/Fax

Practice location:
  • Phone: 978-476-1441
  • Fax: 978-745-7615
Mailing address:
  • Phone: 978-476-1441
  • Fax: 978-745-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: