Provider Demographics
NPI:1346820008
Name:ROSE, MADELINE ANN (LGPC)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:ANN
Last Name:ROSE
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9627 PHILADELPHIA RD STE 160
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4157
Mailing Address - Country:US
Mailing Address - Phone:410-780-5203
Mailing Address - Fax:
Practice Address - Street 1:9627 PHILADELPHIA RD STE 160
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4157
Practice Address - Country:US
Practice Address - Phone:410-780-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10935101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health