=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346432101
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSEMARY MACNIVEN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2007
-----------------------------------------------------
Last Update Date | 08/15/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3074 WHITNEY AVE BUILDING #2 - SECOND FLOOR
-----------------------------------------------------
City | HAMDEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06518-2391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-589-6107
-----------------------------------------------------
Fax | 203-248-5623
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1125 W WOODS RD UNIT 29
-----------------------------------------------------
City | HAMDEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06518-1774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-589-6107
-----------------------------------------------------
Fax | 203-248-5623
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 002847
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------