Healthcare Provider Details

I. General information

NPI: 1003485400
Provider Name (Legal Business Name): ROSE ANZEL LMSW, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S PRESA ST
SAN ANTONIO TX
78210-2841
US

IV. Provider business mailing address

524 REFUGIO ST
SAN ANTONIO TX
78210-1029
US

V. Phone/Fax

Practice location:
  • Phone: 210-343-2545
  • Fax:
Mailing address:
  • Phone: 617-312-1125
  • 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 Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: