Provider Information for 1154834521
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Mr. MARCELLUS ANTHONY ROSE III LCSW
Sex: Male
NPI: 1154834521
Last Updated: 2017-11-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1154834521 | ||||||||
| Enumeration Date | 2017-11-08 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4607 N SHERIDAN RD APT 309 CHICAGO, IL 60640-6515 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 4607 N SHERIDAN RD APT 309 CHICAGO, IL 60640-6515 United States Phone: 309-310-4041 | Fax: | ||||||||
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