Healthcare Provider Details

I. General information

NPI: 1700632403
Provider Name (Legal Business Name): STEPHANIE HANEY ROSE LICSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 RYE CIR
SOUTH BURLINGTON VT
05403-7632
US

IV. Provider business mailing address

27 RYE CIR
SOUTH BURLINGTON VT
05403-7632
US

V. Phone/Fax

Practice location:
  • Phone: 802-654-7607
  • Fax: 802-654-9155
Mailing address:
  • Phone: 802-654-7607
  • Fax: 802-654-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE HANEY ROSE
Title or Position: SOLE MEMBER
Credential: LICSW
Phone: 802-324-0348