Provider Demographics
NPI:1497637375
Name:ROSEN, MARTHA T (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:T
Last Name:ROSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:TILLIE OR TILGHMAN
Other - Middle Name:P
Other - Last Name:ROSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1855 CRANE RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-982-8700
Mailing Address - Fax:
Practice Address - Street 1:1855 CRANE RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-982-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC27051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical