Provider Demographics
NPI:1689458440
Name:SAINT ELIEN, ROSE M
Entity Type:Individual
Prefix:
First Name:ROSE M
Middle Name:
Last Name:SAINT ELIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-4440
Mailing Address - Country:US
Mailing Address - Phone:609-230-9359
Mailing Address - Fax:
Practice Address - Street 1:3108 WATERFORD DR
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-4440
Practice Address - Country:US
Practice Address - Phone:609-230-9359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072325-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker