Healthcare Provider Details

I. General information

NPI: 1114064730
Provider Name (Legal Business Name): CARLOS ALFREDO GUERRERO ROSAS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 CLAY ST STE 150
OAKLAND CA
94607-3510
US

IV. Provider business mailing address

747 52ND ST
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3885
  • Fax: 510-238-9764
Mailing address:
  • Phone: 510-428-3885
  • Fax: 510-238-9764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 66163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: