=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235213240
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSEMARIE GERMAINE SERGI LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 07/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 VICTORY RD SOUTH SHORE MENTAL HEALTH
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-774-1040
-----------------------------------------------------
Fax | 617-847-0915
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 VICTORY RD
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-774-1053
-----------------------------------------------------
Fax | 617-847-0915
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 1015368
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------