Provider Demographics
NPI:1831997428
Name:ROSE, LIBERTY N (CSW)
Entity type:Individual
Prefix:
First Name:LIBERTY
Middle Name:N
Last Name:ROSE
Suffix:
Gender:
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 BENSON DR APT 3
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-5634
Mailing Address - Country:US
Mailing Address - Phone:859-358-9051
Mailing Address - Fax:
Practice Address - Street 1:760 BENSON DR APT 3
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-5634
Practice Address - Country:US
Practice Address - Phone:859-358-9051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2599481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical