MEDICARE: MS. KAREN M ROSE MFT

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	106H00000X	Marriage & Family Therapist	MFC19122	CA

General Provider Information

NPI Number	:	1235113077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN M ROSE MFT

Provider Business Mailing Address
First Line	:	1522 ADDISON ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-1454
Country	:	US
Telephone Number	:	510-486-1188
Fax Number	:	720-204-4534

Provider Business Practice Location Address
First Line	:	2000 HEARST AVE STE 203A
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94709-2260
Country	:	US
Telephone Number	:	510-486-1188
Fax Number	:	720-204-4534

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	02/14/2024

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