Provider Demographics
NPI:1912464132
Name:ROSE, ALISON NICOLE (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:NICOLE
Last Name:ROSE
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:MISS
Other - First Name:ALISON
Other - Middle Name:NICOLE
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:1449 WESTVALE AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6581
Mailing Address - Country:US
Mailing Address - Phone:330-472-9379
Mailing Address - Fax:
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1702
Practice Address - Country:US
Practice Address - Phone:330-472-9379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0700305-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical