Provider Demographics
NPI:1558833939
Name:ROSE, BEX (MSED)
Entity Type:Individual
Prefix:
First Name:BEX
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:BEX
Other - Middle Name:
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSED
Mailing Address - Street 1:555 OVINGTON AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1749
Mailing Address - Country:US
Mailing Address - Phone:718-954-5627
Mailing Address - Fax:
Practice Address - Street 1:555 OVINGTON AVE APT 3C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1749
Practice Address - Country:US
Practice Address - Phone:718-954-5627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY552388097101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health