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General NPI Number Information
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NPI Number | 1720638711
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Entity Type | Organization
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Legal Business Name | KEVIN ROSE PLLC
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 42189 ANN ARBOR RD E
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City | PLYMOUTH
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State | MI
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Zip | 48170-4370
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Country | US
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Telephone | 734-776-1605
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Fax |
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Provider Business Mailing Address
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Address Line | 17387 BRODY AVE
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City | ALLEN PARK
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State | MI
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Zip | 48101-3417
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Country | US
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Telephone | 734-776-1605
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MR. KEVIN WILLIAM ROSE
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Credential | LMSW
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Telephone | 734-776-1605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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