=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831698356
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLISYN ROSE MSW, LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2018
-----------------------------------------------------
Last Update Date | 02/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 413 W CYPRESS ST
-----------------------------------------------------
City | KENNETT SQUARE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19348-3009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-857-2211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 CHURCH ALY
-----------------------------------------------------
City | KENNETT SQUARE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19348-3174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-659-1627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SW133912
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------