Provider Demographics
NPI:1538104708
Name:LAFFERTY, ROSE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 W MAIN CROSS ST
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-2155
Mailing Address - Country:US
Mailing Address - Phone:217-824-6431
Mailing Address - Fax:217-824-6431
Practice Address - Street 1:403 W MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-2155
Practice Address - Country:US
Practice Address - Phone:217-824-6431
Practice Address - Fax:217-824-6431
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0027121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical