Healthcare Provider Details

I. General information

NPI: 1083234637
Provider Name (Legal Business Name): JESSICA LOREN ROSA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 KNELL'S RIDGE BLVD, CHESAPEAKE, VA 23320
CHESAPEAKE VA
23320
US

IV. Provider business mailing address

70 KNELL'S RIDGE BLVD, CHESAPEAKE, VA 23320
CHESAPEAKE VA
23320
US

V. Phone/Fax

Practice location:
  • Phone: 757-722-9961
  • Fax:
Mailing address:
  • Phone: 757-722-9961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904011434
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: