Jennifer Beth Rose, LISW
Social Worker, Clinical in Rio Rancho, NM. Individual provider (NPI-1).
NPI number1104864255
StatusActive
Last updated in NPPESFeb 12, 2024
Details
- NPI
- 1104864255
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Jennifer Beth Rose
- Credential
- LISW
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jun 2, 2006
- Certification date
- Feb 12, 2024
- Last updated
- Feb 12, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | C-06999 | NM | Yes |
Practice location
2111 Golf Course Rd Se Ste DRio Rancho, NM 87124-1634
Phone 505-639-1312
Mailing address
2111 Golf Course Rd Se Ste DRio Rancho, NM 87124-1634
Phone 505-639-1312
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