MEDICARE: MR. MICHAEL JOSEPH ROSE LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801099644	MI
2	104100000X	Social Worker	6801099644	MI

General Provider Information

NPI Number	:	1154762052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL JOSEPH ROSE LMSW

Provider Business Mailing Address
First Line	:	9001 MILLER RD STE 5C
Second Line	:
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473-1115
Country	:	US
Telephone Number	:	810-370-0370
Fax Number	:	810-820-3566

Provider Business Practice Location Address
First Line	:	9001 MILLER RD STE 5C
Second Line	:
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473-1115
Country	:	US
Telephone Number	:	810-370-0370
Fax Number	:	810-820-3566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2013
Last Update Date	:	10/08/2025

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