Healthcare Provider Details

I. General information

NPI: 1740421908
Provider Name (Legal Business Name): ROSE SELIGSON L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSE JIMENEZ L.C.S.W.

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 CALLE ARAGON UNIT 'O'
LAGUNA WOODS CA
92637
US

IV. Provider business mailing address

256 CALLE ARAGON UNIT 'O'
LAGUNA WOODS CA
92637
US

V. Phone/Fax

Practice location:
  • Phone: 949-598-0855
  • Fax:
Mailing address:
  • Phone: 949-598-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number#L5472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: