Provider Demographics
NPI:1598377822
Name:ROSEN, SHELLEY JOY (LMFT)
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:JOY
Last Name:ROSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 W ADAMS ST APT 407
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-3620
Mailing Address - Country:US
Mailing Address - Phone:904-525-3173
Mailing Address - Fax:
Practice Address - Street 1:31 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-3605
Practice Address - Country:US
Practice Address - Phone:904-525-3173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2781106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist