Healthcare Provider Details

I. General information

NPI: 1578022604
Provider Name (Legal Business Name): ROSALEEN MARIE WEDDLE LANCET ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W HALEY ST STE 102
SANTA BARBARA CA
93101-8052
US

IV. Provider business mailing address

1489 CHAPPARRAL DR
CARPINTERIA CA
93013-1316
US

V. Phone/Fax

Practice location:
  • Phone: 805-363-0902
  • Fax: 805-963-5061
Mailing address:
  • Phone: 805-280-1296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number96290
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number96290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: