Provider Information for 1922383595
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Ms. JACQUELINE E ROSE LMSW
Sex: Female
NPI: 1922383595
Last Updated: 2024-08-14
Certification Date: 2024-08-12
Certification Date: 2024-08-12
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1922383595 | ||||||||||||
| Enumeration Date | 2011-10-14 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 789 GILMORE AVE NORTH TONAWANDA, NY 14120 United States Phone: 716-807-3753 | Fax:716-870-3751 | ||||||||||||
| Primary Practice Address | 789 GILMORE AVE NORTH TONAWANDA, NY 14120-6743 United States Phone: 716-807-3753 | Fax:716-870-3751 | ||||||||||||
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