| NPI | 1508809831 |
|---|---|
| Former Name | STEPHANIE LISA ROSE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 340874) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 31221) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2025-12-05 |