Healthcare Provider Details

I. General information

NPI: 1568218733
Provider Name (Legal Business Name): CAROLYNN ROSEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2024
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 MILL STREET
LOWER LAKE CA
95457
US

IV. Provider business mailing address

PO BOX 94
MIDDLETOWN CA
95461-0094
US

V. Phone/Fax

Practice location:
  • Phone: 707-802-8144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW135779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: