Provider Demographics
NPI:1063649333
Name:ROSEN, KATHLEEN THOMAS (LISW-S)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:THOMAS
Last Name:ROSEN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 SADDLE BROOK LN
Mailing Address - Street 2:2C
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-6168
Mailing Address - Country:US
Mailing Address - Phone:216-392-5011
Mailing Address - Fax:
Practice Address - Street 1:26040 DETROIT RD
Practice Address - Street 2:SUITE 3
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2481
Practice Address - Country:US
Practice Address - Phone:216-392-5011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0005350-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical