MEDICARE: MS. JACQUELINE S ROSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	089.0135201	VT
2	1041C0700X	Clinical Social Worker	44SC05767100	NJ
3	1041C0700X	Clinical Social Worker	092563	NY
4	1041C0700X	Clinical Social Worker	LW61541452	WA
5	1041C0700X	Clinical Social Worker	086545	NY

General Provider Information

NPI Number	:	1518305028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE S ROSE

Provider Business Mailing Address
First Line	:	134 N 4TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11249-3296
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	139 CENTRE ST STE 824
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-4558
Country	:	US
Telephone Number	:	646-450-7748
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2013
Last Update Date	:	08/07/2024

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