Provider Demographics
NPI:1487829982
Name:ROSE, LINDAMARIE (MSW, LISW)
Entity Type:Individual
Prefix:MS
First Name:LINDAMARIE
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:MARIE
Other - Last Name:REXROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2221 DAKOTA DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-9080
Mailing Address - Country:US
Mailing Address - Phone:575-312-2216
Mailing Address - Fax:575-312-2216
Practice Address - Street 1:2221 DAKOTA DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-9080
Practice Address - Country:US
Practice Address - Phone:575-312-2216
Practice Address - Fax:575-312-2216
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-07210101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ160940Medicaid