Rose, Jacqueline E

Rose, Jacqueline E is an individual health care provider with primary practice located at 789 Gilmore Ave , North Tonawanda NY 14120-6743. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / School. Behavioral Health & Social Service Providers / School is her primary health care specialty. Rose, Jacqueline E can be contacted via phone (716) 807-3753.

Contact Information

Primary practice address
789 Gilmore Ave North Tonawanda NY 14120-6743
Phone: (716) 807-3753
Fax: (716) 870-3751
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 088228 New York
Behavioral Health & Social Service Providers / School 1041S0200X 39487 New York

Profile Details

NPI number 1922383595
LBN Legal business name Rose, Jacqueline E
Credentials LMSW
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 14th, 2011
Last updated Aug 14th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922383595 NPPES
New York MEDICAID 01377162

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