Provider Demographics
NPI:1326142076
Name:MORTON, ROSE MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
Last Name:MORTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 SHAMROCK COURT
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553
Mailing Address - Country:US
Mailing Address - Phone:228-497-0690
Mailing Address - Fax:228-497-1363
Practice Address - Street 1:3407 SHAMROCK COURT
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553
Practice Address - Country:US
Practice Address - Phone:228-497-0690
Practice Address - Fax:228-497-1363
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM7520104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018214Medicaid