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General NPI Number Information
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NPI Number | 1962659904
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Entity Type | Individual
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Provider Name | ANANDA ENGBER ROSA LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 221 N EAST AVE SUITE #102
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-5226
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Country | US
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Telephone | 479-871-1888
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Fax |
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Provider Business Mailing Address
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Address Line | 221 N EAST AVE SUITE #102
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-5226
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Country | US
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Telephone | 479-871-1888
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW-1680
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LCSW 1952-C
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License Number State | AR
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