Provider Demographics
NPI:1881753192
Name:ROSE, LILITH M (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:LILITH
Middle Name:M
Last Name:ROSE
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MS
Other - First Name:ELAINE
Other - Middle Name:M
Other - Last Name:SCHREIBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LCSWC
Mailing Address - Street 1:6138 WAYNE AVE
Mailing Address - Street 2:#5
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-6108
Mailing Address - Country:US
Mailing Address - Phone:215-843-7673
Mailing Address - Fax:215-843-2993
Practice Address - Street 1:987 OLD EAGLE SCHOOL RD
Practice Address - Street 2:#712
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087
Practice Address - Country:US
Practice Address - Phone:215-843-7673
Practice Address - Fax:215-843-7633
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0140051041C0700X
MD105031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical