Provider Demographics
NPI:1720064066
Name:ROSSE, KATHRYN M (MSW)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:M
Last Name:ROSSE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 CHESTNUT ST
Mailing Address - Street 2:#804
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-3401
Mailing Address - Country:US
Mailing Address - Phone:215-864-0132
Mailing Address - Fax:
Practice Address - Street 1:1240 S BROAD ST
Practice Address - Street 2:SUITE 220
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-5395
Practice Address - Country:US
Practice Address - Phone:215-699-3901
Practice Address - Fax:215-699-3909
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0121251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical