Provider Demographics
NPI:1295549533
Name:ROSE, JEFFREY GILBERT SR (LADC II, CARC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:GILBERT
Last Name:ROSE
Suffix:SR
Gender:M
Credentials:LADC II, CARC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 THOMAS B LANDERS RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-4786
Mailing Address - Country:US
Mailing Address - Phone:508-524-3385
Mailing Address - Fax:
Practice Address - Street 1:269 THOMAS B LANDERS RD UNIT B
Practice Address - Street 2:
Practice Address - City:EAST FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02536-4786
Practice Address - Country:US
Practice Address - Phone:508-524-3385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20582101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)