Rose R Jeter, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904009125 Issued in VA

Practice address

115 S Sycamore St
Suite B
Petersburg, VA 23803-4279

Phone

(804) 835-9511

Fax

(804) 479-3373

NPI assigned

Mar 11, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 1, 2024 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ernest Jeter, Msed

  • Early Intervention Provider Agency
  • Petersburg, VA
  • NPI 1497261598
  NPD (past)

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

{
    "created_epoch": "1457654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464393600000",
    "number": "1750742201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 S SYCAMORE ST",
            "address_2": "SUITE B",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238034279",
            "telephone_number": "804-835-9511",
            "fax_number": "804-479-3373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 S SYCAMORE ST",
            "address_2": "SUITE B",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238034279",
            "telephone_number": "804-835-9511",
            "fax_number": "804-479-3373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JETER",
        "first_name": "ROSE",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-11",
        "last_updated": "2016-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904009125",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "083428",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna R Jaris, PSY.D.
• Valerie L Jaskowski, FNP
• Cynthia Lynn Jenkins, PH.D.
• Randolph Mitchell Jenkins Jr., M.D.
• Ernest Jeter
• Xiao Hong Jin, MD
• John T. Marshall M.D P.C
• John W Lynn DDS LTD
• Ellyse Johns, PT
• Ashley P B Johnson, CD, BEC

• Clinical Social Worker in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.