Individual
MARY JO LAROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
34006321A
IN
1041C0700X
Clinical Social Worker
2017004755
MO
1041C0700X
Clinical Social Worker
Primary
340006321A
IN
1041C0700X
Clinical Social Worker
Primary
34006321A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34006321A
LICENSE
IN
Enumeration date
04/09/2014
Last updated
03/11/2026
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