Healthcare Provider Details

I. General information

NPI: 1932023603
Provider Name (Legal Business Name): ROSE VON BLANCK LMFT, MA ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 CREEKSIDE DR STE 106
FOLSOM CA
95630-3538
US

IV. Provider business mailing address

9012 CEDAR RIDGE DR
GRANITE BAY CA
95746-7237
US

V. Phone/Fax

Practice location:
  • Phone: 818-383-4792
  • Fax:
Mailing address:
  • Phone: 818-383-4792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: