Provider Demographics
NPI:1669488508
Name:ROSE, BARBARA R (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:R
Last Name:ROSE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 BEGONIA ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2869
Mailing Address - Country:US
Mailing Address - Phone:719-564-8013
Mailing Address - Fax:
Practice Address - Street 1:720 N MAIN ST
Practice Address - Street 2:SUITE 335
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3020
Practice Address - Country:US
Practice Address - Phone:719-738-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO991924101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health