Provider Demographics
NPI:1154762052
Name:ROSE, MICHAEL JOSEPH (LMSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:ROSE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9104 CEDAR BEND DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-3420
Mailing Address - Country:US
Mailing Address - Phone:810-603-7665
Mailing Address - Fax:810-603-7665
Practice Address - Street 1:9104 CEDAR BEND DR
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-3420
Practice Address - Country:US
Practice Address - Phone:989-627-8748
Practice Address - Fax:810-963-2485
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801099644104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical