Provider Demographics
NPI:1902998982
Name:ROSE, SHEILA V (MS)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:V
Last Name:ROSE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 EIGHTH ST
Mailing Address - Street 2:
Mailing Address - City:MARLINTON
Mailing Address - State:WV
Mailing Address - Zip Code:24954
Mailing Address - Country:US
Mailing Address - Phone:304-799-0815
Mailing Address - Fax:304-799-0809
Practice Address - Street 1:221 EIGHTH ST
Practice Address - Street 2:
Practice Address - City:MARLINTON
Practice Address - State:WV
Practice Address - Zip Code:24954
Practice Address - Country:US
Practice Address - Phone:304-799-0815
Practice Address - Fax:304-799-0809
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV796103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002572Medicaid
4206411Medicare PIN