Provider Demographics
NPI:1306044920
Name:ROSE, JULIE A (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:ROSE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S OYSTER BAY RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3500
Mailing Address - Country:US
Mailing Address - Phone:516-880-4831
Mailing Address - Fax:
Practice Address - Street 1:400 S OYSTER BAY RD
Practice Address - Street 2:SUITE 208
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3500
Practice Address - Country:US
Practice Address - Phone:516-880-4831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6426420511041S0200X
NYR077326-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool