Healthcare Provider Details

I. General information

NPI: 1205348034
Provider Name (Legal Business Name): JONATHAN JAMES LA ROSA MSW, ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HUGHES WAY
LONG BEACH CA
90810-1876
US

IV. Provider business mailing address

1501 HUGHES WAY
LONG BEACH CA
90810-1876
US

V. Phone/Fax

Practice location:
  • Phone: 310-221-6336
  • Fax: 310-221-6350
Mailing address:
  • Phone: 310-221-6336
  • Fax: 310-221-6350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW79782
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW79782
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: