Provider Demographics
NPI:1588928857
Name:WRIGHT, ROSE LUCY AUGUSTIN (MA)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:LUCY AUGUSTIN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 SENECA CLUB LOOP UNIT C
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-3179
Mailing Address - Country:US
Mailing Address - Phone:407-497-3716
Mailing Address - Fax:
Practice Address - Street 1:1317 EDGEWATER DR STE 4275
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6350
Practice Address - Country:US
Practice Address - Phone:407-850-8785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-01
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 9875101YM0800X
FL19390101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health