Provider Demographics
NPI:1609124130
Name:ROSE, ERICKA (MHC)
Entity Type:Individual
Prefix:MS
First Name:ERICKA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CHELSEA PL
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3216
Mailing Address - Country:US
Mailing Address - Phone:518-691-0732
Mailing Address - Fax:
Practice Address - Street 1:6 CHELSEA PL
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3216
Practice Address - Country:US
Practice Address - Phone:518-691-0732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health