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General NPI Number Information
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NPI Number | 1811123540
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Entity Type | Organization
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Legal Business Name | MEG ROSE, MS, LCSW, LLC
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 06/09/2009
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Provider Practice Location Address
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Address Line | 63 CHURCH ST
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City | GUILFORD
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State | CT
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Zip | 06437-2604
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Country | US
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Telephone | 203-640-6984
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Fax | 203-453-9212
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Provider Business Mailing Address
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Address Line | 134 RUSSETT DR
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City | GUILFORD
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State | CT
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Zip | 06437-1847
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Country | US
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Telephone | 203-640-6984
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Fax | 203-453-9212
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Authorized Official
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Title or Position | OWNER
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Name | MARGARET (MEG) ROSE
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Credential | LCSW
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Telephone | 203-640-6984
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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 | 004756
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License Number State | CT
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