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General NPI Number Information
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NPI Number | 1568218733
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Entity Type | Individual
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Provider Name | CAROLYNN ROSEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/27/2024
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 9800 MILL STREET
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City | LOWER LAKE
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State | CA
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Zip | 95457
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Country | US
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Telephone | 707-802-8144
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 94
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City | MIDDLETOWN
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State | CA
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Zip | 95461-0094
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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 | LCSW135779
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License Number State | CA
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