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General NPI Number Information
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NPI Number | 1831661024
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Entity Type | Individual
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Provider Name | ROSANNE JANES DERIX LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/28/2018
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 107 WILCOX RD STE 107E
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City | STONINGTON
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State | CT
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Zip | 06378-2614
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Country | US
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Telephone | 860-295-4371
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Fax |
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Provider Business Mailing Address
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Address Line | 9 LYNN LN
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City | ASHAWAY
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State | RI
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Zip | 02804-1313
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Country | US
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Telephone | 401-932-3137
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 010988
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License Number State | CT
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Taxonomy #2
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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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