Provider Demographics
NPI:1093077414
Name:ROSEN, ELYSE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:ROSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 SCOTT BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-6800
Mailing Address - Country:US
Mailing Address - Phone:254-773-4022
Mailing Address - Fax:254-773-0919
Practice Address - Street 1:3010 SCOTT BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504
Practice Address - Country:US
Practice Address - Phone:254-773-4022
Practice Address - Fax:254-773-0919
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX301831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical