Provider Demographics
NPI:1932259926
Name:KAISER, ROSEMARIE PANIDES (LCSW)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:PANIDES
Last Name:KAISER
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 1:140 LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6813
Mailing Address - Country:US
Mailing Address - Phone:912-729-5501
Mailing Address - Fax:
Practice Address - Street 1:140 LAKES BLVD
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6813
Practice Address - Country:US
Practice Address - Phone:912-729-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0012861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical