Basic Information
| Provider Information | |||||||||
| NPI: | 1053830331 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSENE | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | LAUREN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW, MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7927 W CRESSETT DR | ||||||||
| Address2: | |||||||||
| City: | ELMWOOD PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607071346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083057391 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9855 W ROOSEVELT RD | ||||||||
| Address2: | |||||||||
| City: | WESTCHESTER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601542758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086812325 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2017 | ||||||||
| LastUpdateDate: | 09/18/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.