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General NPI Number Information
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NPI Number | 1457097099
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Entity Type | Organization
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Legal Business Name | ANDREA P. ROSE, LICENSED CLINICAL SOCIAL WORKER, INC.
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Dates
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Enumeration Date | 05/06/2022
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 3411 3RD AVE
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City | SAN DIEGO
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State | CA
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Zip | 92103-4906
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Country | US
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Telephone | 619-993-3883
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Fax | 619-330-7124
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Provider Business Mailing Address
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Address Line | 4346 HILL ST
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City | SAN DIEGO
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State | CA
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Zip | 92107-4117
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Country | US
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Telephone | 619-417-8811
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Fax |
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Authorized Official
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Title or Position | LCSW/PRESIDENT
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Name | ANDREA P. ROSE
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Credential | LCSW
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Telephone | 619-993-3883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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