Provider Demographics
NPI:1750993002
Name:ROSEMEDWARDSLCSW-C, LLC
Entity type:Organization
Organization Name:ROSEMEDWARDSLCSW-C, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER, SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-900-7145
Mailing Address - Street 1:720 HOLLEN RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2718
Mailing Address - Country:US
Mailing Address - Phone:443-900-7145
Mailing Address - Fax:
Practice Address - Street 1:2360 W JOPPA RD STE 229
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4664
Practice Address - Country:US
Practice Address - Phone:443-900-7145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11523570OtherCAQH
MD333369800Medicaid