Provider Demographics
NPI:1790356392
Name:ROSE, CHARITY AARYN (LSW)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:AARYN
Last Name:ROSE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:AARYN
Other - Last Name:SHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:880 GRANT CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-9696
Mailing Address - Country:US
Mailing Address - Phone:317-250-4185
Mailing Address - Fax:
Practice Address - Street 1:7550 S MERIDIAN ST STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-2912
Practice Address - Country:US
Practice Address - Phone:317-250-4185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33009321A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker