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General NPI Number Information
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NPI Number | 1396394359
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Entity Type | Organization
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Legal Business Name | GARY S. ROSE PH.D. LLC
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 45 WALDEN ST STE 1
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City | CONCORD
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State | MA
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Zip | 01742-2513
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Country | US
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Telephone | 978-250-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 7 COACHMEN LN
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City | BEDFORD
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State | MA
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Zip | 01730-2027
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Country | US
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Telephone | 978-250-8400
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | GARY ROSE
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Credential | PH.D.
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Telephone | 978-250-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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