Provider Demographics
NPI:1700632403
Name:STEPHANIE HANEY ROSE LICSW, PLLC
Entity Type:Organization
Organization Name:STEPHANIE HANEY ROSE LICSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:HANEY
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-324-0348
Mailing Address - Street 1:27 RYE CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7632
Mailing Address - Country:US
Mailing Address - Phone:802-654-7607
Mailing Address - Fax:802-654-9155
Practice Address - Street 1:27 RYE CIR
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7632
Practice Address - Country:US
Practice Address - Phone:802-654-7607
Practice Address - Fax:802-654-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty