Provider Demographics
NPI:1225130735
Name:ROSE, MARGARET P (LCSW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:P
Last Name:ROSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1172 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1323
Mailing Address - Country:US
Mailing Address - Phone:570-424-6187
Mailing Address - Fax:570-424-6271
Practice Address - Street 1:1172 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1323
Practice Address - Country:US
Practice Address - Phone:570-424-6187
Practice Address - Fax:570-424-6271
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0198211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW019821OtherPA LICENSE
11244299OtherCAQH
268814OtherMHN
PA103466744Medicaid
PA642337HYZOtherMEDICARE NUMBER
140004756CT01OtherANTHEM BEHAVIORAL HEALTH
P2751167OtherCONNECTICARE/UNITED BEHAVIORAL HEALTH