Provider Demographics
NPI:1811769177
Name:KLOSS, EDELE ROSE (MA, MT-BC, LPC)
Entity type:Individual
Prefix:
First Name:EDELE
Middle Name:ROSE
Last Name:KLOSS
Suffix:
Gender:F
Credentials:MA, MT-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-1327
Mailing Address - Country:US
Mailing Address - Phone:484-410-5441
Mailing Address - Fax:
Practice Address - Street 1:8 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-1327
Practice Address - Country:US
Practice Address - Phone:484-410-5441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC016234101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional