Healthcare Provider Details

I. General information

NPI: 1538894282
Provider Name (Legal Business Name): BRYAN TORRES ROSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 10/11/2026
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LIBERTY ST STE 100
SPRINGFIELD MA
01103-1109
US

IV. Provider business mailing address

125 LIBERTY ST STE 100
SPRINGFIELD MA
01103-1109
US

V. Phone/Fax

Practice location:
  • Phone: 413-301-7797
  • Fax:
Mailing address:
  • Phone: 413-301-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: