Healthcare Provider Details

I. General information

NPI: 1326259979
Provider Name (Legal Business Name): DOROTHY M ROSE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 MONTICELLO DR S
SYRACUSE NY
13205-2809
US

IV. Provider business mailing address

214 MONTICELLO DR S
SYRACUSE NY
13205-2809
US

V. Phone/Fax

Practice location:
  • Phone: 315-329-0220
  • Fax:
Mailing address:
  • Phone: 315-329-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000088-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: