Provider Demographics
NPI:1073732970
Name:CLEMENT, ROSE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:HENNESSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-3168
Mailing Address - Country:US
Mailing Address - Phone:970-522-4549
Mailing Address - Fax:970-522-9544
Practice Address - Street 1:211 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-3168
Practice Address - Country:US
Practice Address - Phone:970-522-4549
Practice Address - Fax:970-522-9544
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW-5261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical