Provider Demographics
NPI:1003359332
Name:ROSE, HANNAH ELISE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:HANNAH
Middle Name:ELISE
Last Name:ROSE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W 40TH STREET
Mailing Address - Street 2:SUITE 425
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211
Mailing Address - Country:US
Mailing Address - Phone:443-845-1573
Mailing Address - Fax:443-787-0306
Practice Address - Street 1:711 W 40TH STREET
Practice Address - Street 2:SUITE 425
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211
Practice Address - Country:US
Practice Address - Phone:443-845-1573
Practice Address - Fax:443-787-0306
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7930101YP2500X
MDLGP6742101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health