Healthcare Provider Details

I. General information

NPI: 1023186939
Provider Name (Legal Business Name): ROSE GUGGENHEIM MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 WHIPPLE RD
UNION CITY CA
94587-1507
US

IV. Provider business mailing address

3555 WHIPPLE ROAD,
UNION CITY CA
94587
US

V. Phone/Fax

Practice location:
  • Phone: 510-675-4541
  • Fax: 510-675-4315
Mailing address:
  • Phone: 510-675-4541
  • Fax: 510-675-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMFC29053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: