Provider Demographics
NPI:1932381787
Name:ROSE, JEFFREY LEE (LPC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEE
Last Name:ROSE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6512
Mailing Address - Country:US
Mailing Address - Phone:802-275-5655
Mailing Address - Fax:
Practice Address - Street 1:300 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6512
Practice Address - Country:US
Practice Address - Phone:802-275-5655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2416101YP2500X
VT068.0134115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional