La Rose, Dana Jo

La Rose, Dana Jo is an sole proprietor health care provider with primary practice located at 29 Madison St , Rutland VT 05701-5004. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. La Rose, Dana Jo can be contacted via phone (802) 345-9495.

Contact Information

Primary practice address
29 Madison St Rutland VT 05701-5004
Phone: (802) 345-9495
Fax: (802) 775-9698
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 000141 Vermont
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 103454 Vermont
Behavioral Health & Social Service Providers / Mental Health 101YM0800X Vermont

Profile Details

NPI number 1457361875
LBN Legal business name La Rose, Dana Jo
Credentials LICSW, LADC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 8th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457361875 NPPES
Vermont MEDICAID 0VN1124
Vermont Other 613355
Vermont Other 19888

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