Healthcare Provider Details

I. General information

NPI: 1225558752
Provider Name (Legal Business Name): TERRY HARVEY-ROSE BSW, MAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12256 CREEK EDGE DR
RIVERVIEW FL
33579-6500
US

IV. Provider business mailing address

12256 CREEK EDGE DR
RIVERVIEW FL
33579-6500
US

V. Phone/Fax

Practice location:
  • Phone: 813-323-3597
  • Fax:
Mailing address:
  • Phone: 813-323-3597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: