Provider Demographics
NPI:1356028591
Name:ROSE, BOBBIJEAN (CADC)
Entity type:Individual
Prefix:
First Name:BOBBIJEAN
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 LISBON ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5025
Mailing Address - Country:US
Mailing Address - Phone:207-783-9141
Mailing Address - Fax:
Practice Address - Street 1:49 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2014
Practice Address - Country:US
Practice Address - Phone:207-364-7981
Practice Address - Fax:207-364-7983
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)