Individual
MS. ERICA LATOYA ROSEBORO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN
Contact information
Practice address
105 MERRICK ST, WORCESTER, MA 01609-1937
(508) 797-6100
(508) 797-0693
Mailing address
585 LINCOLN ST, WORCESTER, MA 01605-1906
(508) 854-3320
(508) 753-5051
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306421
—
MA
05
—
1308785
—
MA
01
—
2220002001
BCBS
MA
01
—
M18684
BCBS MH
MA
01
—
Y10400
MEDICARE GROUP NUMBER
MA
Enumeration date
09/04/2007
Last updated
09/04/2007
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