Individual
BRANDON ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
1575 WASHINGTON ST, WATERTOWN, NY 13601-9371
(315) 779-5060
(315) 779-5028
Mailing address
1575 WASHINGTON ST, WATERTOWN, NY 13601-9371
(315) 779-5060
(315) 779-5028
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03001594
—
NY
Enumeration date
05/30/2019
Last updated
05/30/2019
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