MEDICARE: MS. HEATHER MCLAREN ROSELAREN LCSW/MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS14038	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	152219	OTHER	CA	MANAGED HEALTH NETWORK
2	200152681	OTHER	CA	BLUE CROSS PROVIDER #

General Provider Information

NPI Number	:	1184662603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER MCLAREN ROSELAREN LCSW/MPH

Provider Business Mailing Address
First Line	:	1918 BONITA AVE STE 200
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-1014
Country	:	US
Telephone Number	:	510-527-1217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1918 BONITA AVE STE 200
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-1014
Country	:	US
Telephone Number	:	510-527-1217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	05/19/2021

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