Provider Demographics
NPI:1831661024
Name:DERIX, ROSANNE JANES (LCSW)
Entity type:Individual
Prefix:
First Name:ROSANNE
Middle Name:JANES
Last Name:DERIX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LYNN LN
Mailing Address - Street 2:
Mailing Address - City:ASHAWAY
Mailing Address - State:RI
Mailing Address - Zip Code:02804-1313
Mailing Address - Country:US
Mailing Address - Phone:401-932-3137
Mailing Address - Fax:
Practice Address - Street 1:107 WILCOX RD STE 107E
Practice Address - Street 2:
Practice Address - City:STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06378-2614
Practice Address - Country:US
Practice Address - Phone:860-295-4371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0109881041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical