Provider Demographics
NPI:1629445515
Name:BARTKUS, ROSE ANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:ANNE
Last Name:BARTKUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:ANNE
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:220 MAIN ST APT 4J
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06057-2715
Mailing Address - Country:US
Mailing Address - Phone:203-241-8166
Mailing Address - Fax:
Practice Address - Street 1:220 MAIN ST APT 4J
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06057-2715
Practice Address - Country:US
Practice Address - Phone:203-241-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT86641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1629445515Medicaid