MEDICARE: MS. ROSE L. REIWITCH 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	MFT 20972	CA

General Provider Information

NPI Number	:	1376653592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSE L. REIWITCH MFT

Provider Business Mailing Address
First Line	:	1713 PROFESSIONAL DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-2104
Country	:	US
Telephone Number	:	916-485-4555
Fax Number	:	916-483-3978

Provider Business Practice Location Address
First Line	:	1713 PROFESSIONAL DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-2104
Country	:	US
Telephone Number	:	916-485-4555
Fax Number	:	916-483-3978

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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