Provider Demographics
NPI:1518096981
Name:ROSE, IRMA GARCIA (LCSW, MSW, MA)
Entity Type:Individual
Prefix:MS
First Name:IRMA
Middle Name:GARCIA
Last Name:ROSE
Suffix:
Gender:F
Credentials:LCSW, MSW, MA
Other - Prefix:MS
Other - First Name:IRMA
Other - Middle Name:JOSEFINA
Other - Last Name:GARCIA-CASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, MA
Mailing Address - Street 1:1012 N 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2602
Mailing Address - Country:US
Mailing Address - Phone:706-232-1111
Mailing Address - Fax:706-378-3435
Practice Address - Street 1:1012 N 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2602
Practice Address - Country:US
Practice Address - Phone:706-232-1111
Practice Address - Fax:706-387-3435
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0028371041C0700X
NY02524911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11622429OtherCAQH
11622429OtherCAQH