Provider Demographics
NPI:1255900460
Name:MAIRE, ROSE MARGARET (LCADC, CCS, MAC)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MARGARET
Last Name:MAIRE
Suffix:
Gender:F
Credentials:LCADC, CCS, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4723
Mailing Address - Country:US
Mailing Address - Phone:973-783-6655
Mailing Address - Fax:973-223-1396
Practice Address - Street 1:104 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4723
Practice Address - Country:US
Practice Address - Phone:973-783-6655
Practice Address - Fax:973-223-1396
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00036500101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)