Provider Demographics
NPI:1184743833
Name:MCINTYRE, ROSE E (ACSW, LISW)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:E
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:ACSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3583 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1314
Mailing Address - Country:US
Mailing Address - Phone:216-831-6466
Mailing Address - Fax:216-766-6084
Practice Address - Street 1:24200 CHAGRIN BLVD
Practice Address - Street 2:THE OFFICE PLACE
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5550
Practice Address - Country:US
Practice Address - Phone:216-831-6466
Practice Address - Fax:216-766-6084
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00007391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMCSW29021Medicare ID - Type Unspecified
OHQ39876Medicare UPIN