Provider Demographics
NPI:1578507240
Name:RODNEZ-SIMPSON, ROSE ANESTA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:ANESTA
Last Name:RODNEZ-SIMPSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5582 HOBNAIL CIR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1628
Mailing Address - Country:US
Mailing Address - Phone:248-730-0602
Mailing Address - Fax:
Practice Address - Street 1:5582 HOBNAIL CIR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-1628
Practice Address - Country:US
Practice Address - Phone:248-730-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010801591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical