Provider Demographics
NPI:1316277759
Name:VOSE, ROBERTA ELLEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:ELLEN
Last Name:VOSE
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 1:214 TYREE LN
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4135
Mailing Address - Country:US
Mailing Address - Phone:407-765-1653
Mailing Address - Fax:407-645-1123
Practice Address - Street 1:214 TYREE LN
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4135
Practice Address - Country:US
Practice Address - Phone:407-765-1653
Practice Address - Fax:407-645-1123
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW96821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical