Healthcare Provider Details

I. General information

NPI: 1356865430
Provider Name (Legal Business Name): ROSELYNE DEMORCY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 07/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 GORE ST
EAST CAMBRIDGE MA
02141-1119
US

IV. Provider business mailing address

1035 CAMBRIDGE ST STE 26
CAMBRIDGE MA
02141-1154
US

V. Phone/Fax

Practice location:
  • Phone: 617-806-8783
  • Fax:
Mailing address:
  • Phone: 617-806-8783
  • Fax: 617-806-8750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: