Provider Demographics
NPI:1053379602
Name:ROSE, JANE C (LCSW)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:C
Last Name:ROSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 YANCEY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-3322
Mailing Address - Country:US
Mailing Address - Phone:434-575-8255
Mailing Address - Fax:434-572-1616
Practice Address - Street 1:515 YANCEY ST
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-3322
Practice Address - Country:US
Practice Address - Phone:434-575-8255
Practice Address - Fax:434-572-1616
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040027341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008917531Medicaid
VA087374OtherOPTIMA SENTARA
VA237752OtherVALUE OPTIONS
VA7151705OtherCIGNA
165713000OtherMAGELLAN
VA168077OtherMHN
326561OtherANTHEM HEALTHKEEPERS PLUS
VA98581393OtherUNITED HEALTH CARE
VA98581393OtherUNITED BEHAVIORAL HEALTH
VA326561OtherANTHEM BC/BS
326561OtherTRIGON
VA087374OtherOPTIMA SENTARA