Provider Demographics
NPI:1730354325
Name:NNOLIM, MARY ROSE N (CSW, CAAC)
Entity type:Individual
Prefix:MS
First Name:MARY ROSE
Middle Name:N
Last Name:NNOLIM
Suffix:
Gender:F
Credentials:CSW, CAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4406 PRESERVE DR APT 201
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-8736
Mailing Address - Country:US
Mailing Address - Phone:734-657-7784
Mailing Address - Fax:
Practice Address - Street 1:4406 PRESERVE DR APT 201
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-8736
Practice Address - Country:US
Practice Address - Phone:734-657-7784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801083931104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker