Provider Demographics
NPI:1306528856
Name:BROSE, MAREN (LCSW)
Entity type:Individual
Prefix:
First Name:MAREN
Middle Name:
Last Name:BROSE
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 1:7335 S LEWIS AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6896
Mailing Address - Country:US
Mailing Address - Phone:918-748-5614
Mailing Address - Fax:918-749-7144
Practice Address - Street 1:7335 S LEWIS AVE STE 210
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6896
Practice Address - Country:US
Practice Address - Phone:918-748-5614
Practice Address - Fax:918-749-7144
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK08841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical