Healthcare Provider Details

I. General information

NPI: 1730455296
Provider Name (Legal Business Name): DEBRA SUE ROOKLIN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBRA SUE GOLDSTEIN LMHC

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BLACKSTONE PARK
NORTH QUINCY MA
02171-0004
US

IV. Provider business mailing address

PO BOX 240
NORTH QUINCY MA
02171-0004
US

V. Phone/Fax

Practice location:
  • Phone: 617-532-5554
  • Fax: 617-532-5560
Mailing address:
  • Phone: 617-532-5554
  • Fax: 617-532-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number730
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: