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General NPI Number Information
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NPI Number | 1497319446
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Entity Type | Individual
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Provider Name | NATELY ROSE LCSW
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Gender | Male
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Dates
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Enumeration Date | 04/25/2019
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 2130 STOCKTON BLVD # 100
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City | SACRAMENTO
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State | CA
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Zip | 95817-1337
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Country | US
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Telephone | 916-874-3660
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Fax |
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Provider Business Mailing Address
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Address Line | 4750 J STREET PO BOX 191961
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City | SACRAMENTO
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State | CA
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Zip | 95819-9998
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 116574
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License Number State | CA
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