=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285307694
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THEROSA COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2021
-----------------------------------------------------
Last Update Date | 07/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 67 S BEDFORD ST STE 400
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01803-5108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-512-6012
-----------------------------------------------------
Fax | 781-512-6011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 119 RIDGEFIELD DR
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03055-3031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-759-0542
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED MENTAL HEALTH COUNSELOR
-----------------------------------------------------
Name | MRS. CATHERINE LAMBERT
-----------------------------------------------------
Credential | MS/ED CAGS
-----------------------------------------------------
Telephone | 603-759-0542
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------