Healthcare Provider Details

I. General information

NPI: 1801046305
Provider Name (Legal Business Name): ROSA MARCELA GARCIA SOTO LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 10/22/2022
Certification Date: 10/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

562 BAVARIA LN
CHASKA MN
55318-4597
US

IV. Provider business mailing address

PO BOX 772
EXCELSIOR MN
55331-0772
US

V. Phone/Fax

Practice location:
  • Phone: 612-236-6799
  • Fax:
Mailing address:
  • Phone: 612-236-6799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23759
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: