Healthcare Provider Details

I. General information

NPI: 1184987224
Provider Name (Legal Business Name): ROSE CROUPPEN OXFORD L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 E 2ND ST SUITE 203
LONG BEACH CA
90803-5300
US

IV. Provider business mailing address

5353 E 2ND ST SUITE 203
LONG BEACH CA
90803-5300
US

V. Phone/Fax

Practice location:
  • Phone: 310-490-0965
  • Fax:
Mailing address:
  • Phone: 310-490-0965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW28073
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: