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NPI Code Detail

MEDICARE: MS. MARY ROSE LMFT

MEDICARE: MS. MARY ROSE LMFT
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
1106H00000XMarriage & Family TherapistIL

General Provider Information

NPI Number : 1366537029
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY ROSE LMFT
Provider Business Mailing Address
First Line : 5210 MAIN ST
Second Line :
City : SKOKIE
State : IL
Zip : 60077-2158
Country : US
Telephone Number : 847-425-7503
Fax Number :
Provider Business Practice Location Address
First Line : 5210 MAIN ST
Second Line :
City : SKOKIE
State : IL
Zip : 60077-2158
Country : US
Telephone Number : 847-425-7503
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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Directions to “ MS. MARY ROSE LMFT” Practice Location

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