Provider Demographics
NPI:1225558752
Name:HARVEY-ROSE, TERRY (BSW, MAT)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:HARVEY-ROSE
Suffix:
Gender:F
Credentials:BSW, MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12256 CREEK EDGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-6500
Mailing Address - Country:US
Mailing Address - Phone:813-323-3597
Mailing Address - Fax:
Practice Address - Street 1:12256 CREEK EDGE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-6500
Practice Address - Country:US
Practice Address - Phone:813-323-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool