Provider Demographics
NPI:1477250272
Name:ROSE, HAYLEY SUSAN (MA)
Entity Type:Individual
Prefix:MRS
First Name:HAYLEY
Middle Name:SUSAN
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 1:699 BERKMAR CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1406
Mailing Address - Country:US
Mailing Address - Phone:703-209-8999
Mailing Address - Fax:
Practice Address - Street 1:699 BERKMAR CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1406
Practice Address - Country:US
Practice Address - Phone:703-209-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015532101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health