Individual
DR. MARY W ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D, C.B.S.M
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
31557
TX
173F00000X
Sleep Specialist (PhD)
Primary
3-1557
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
147062701
—
TX
Enumeration date
10/02/2006
Last updated
08/01/2013
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