MEDICARE: MS. NANCY ROSE MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS20465	CA

General Provider Information

NPI Number	:	1164502274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY ROSE MSW

Provider Business Mailing Address
First Line	:	PO BOX 572125
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91357-2125
Country	:	US
Telephone Number	:	818-832-2410
Fax Number	:	818-832-2567

Provider Business Practice Location Address
First Line	:	10605 BALBOA BLVD
Second Line	:	SUITE 100
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-6342
Country	:	US
Telephone Number	:	818-832-2410
Fax Number	:	818-832-2567

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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