| Mary Rose Lcsw, Llc | |
|
1732 S Hadley Rd Fort Wayne IN 46804-1458 | |
| (260) 438-4905 | |
| Not Available |
| Full Name | Mary Rose Lcsw, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1732 S Hadley Rd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Mary Rose Draper (OWNER) |
| Authorized Official Contact | 2604384905 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Rose Lcsw, Llc 1732 S Hadley Rd Fort Wayne IN 46804-1458 Ph: (260) 438-4905 | Mary Rose Lcsw, Llc 1732 S Hadley Rd Fort Wayne IN 46804-1458 Ph: (260) 438-4905 |
| NPI Number | 1083399869 |
|---|---|
| Provider Enumeration Date | 06/19/2023 |
| Last Update Date | 05/05/2024 |
| Certification Date | 05/05/2024 |
| Medicare PECOS PAC ID | 8022464486 |
|---|---|
| Medicare Enrollment ID | O20231023000363 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083399869 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Mary H Rose |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891856399 PECOS PAC ID: 2961473863 Enrollment ID: I20040804000593 |
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