Jon Mitchel Rose, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

RO44407-1 Issued in NY

Practice address

89 Boniface Dr
Pine Bush, NY 12566-7011

Phone

(845) 744-6974

Fax

(845) 744-6406

NPI assigned

Dec 16, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197763200000",
    "number": "1669655494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "89 BONIFACE DR",
            "address_2": "P.O. BOX 912",
            "city": "PINE BUSH",
            "state": "NY",
            "postal_code": "125667011",
            "telephone_number": "845-744-6974",
            "fax_number": "845-744-6406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 BONIFACE DR",
            "city": "PINE BUSH",
            "state": "NY",
            "postal_code": "125667011",
            "telephone_number": "845-744-6974",
            "fax_number": "845-744-6406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "JON",
        "middle_name": "MITCHEL",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-16",
        "last_updated": "2007-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "RO44407-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rite Aid of New York Inc
• Nicolas R Rivera
• Garbrielle Areyanna Robinson
• Michelle Rogowski, OTR
• Jacqueline Rose, L.AC
• Krista Rowe
• Cynthia Lee Russell
• Jo A Santiago, LPN
• Danny Frank Scarano, PHARMD
• Suzanne Marie Scarzafava, P.T.A.

• Clinical Social Worker in Pine Bush, NY
• Providers in Pine Bush, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.