Provider Demographics
NPI:1467601591
Name:ROSE, SHARON (MA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1225
Mailing Address - Street 2:
Mailing Address - City:VOLCANO
Mailing Address - State:HI
Mailing Address - Zip Code:96785-1225
Mailing Address - Country:US
Mailing Address - Phone:808-854-7454
Mailing Address - Fax:
Practice Address - Street 1:17-195 IPUAIWAHA ST
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749-8230
Practice Address - Country:US
Practice Address - Phone:808-966-8849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist