Provider Demographics
NPI:1851519391
Name:ROOS, MARK KAREL (LCSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:KAREL
Last Name:ROOS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CRESTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-2606
Mailing Address - Country:US
Mailing Address - Phone:203-744-4204
Mailing Address - Fax:203-744-4204
Practice Address - Street 1:2505 MAIN ST
Practice Address - Street 2:SUITE NUMBER 208
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5839
Practice Address - Country:US
Practice Address - Phone:203-386-0364
Practice Address - Fax:203-744-4204
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0056201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical