Provider Demographics
NPI:1932668233
Name:ROSE, JESSICA A (LMHC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-3328
Mailing Address - Country:US
Mailing Address - Phone:646-975-0704
Mailing Address - Fax:
Practice Address - Street 1:30 RIDGE RD
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-3328
Practice Address - Country:US
Practice Address - Phone:212-301-0749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-16
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009394-1101YM0800X
NY0093941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health