Healthcare Provider Details

I. General information

NPI: 1992902175
Provider Name (Legal Business Name): ELAINE BELL ROSSEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 HIGHLAND AVE 4TH FLOOR
SALEM MA
01970-2141
US

IV. Provider business mailing address

40R HIGHLAND AVE APARTMENT 510
SALEM MA
01970-2152
US

V. Phone/Fax

Practice location:
  • Phone: 978-354-2700
  • Fax:
Mailing address:
  • Phone: 978-744-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMA202406
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: