MEDICARE: MRS. ADINA RACHEL 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	101YM0800X	Mental Health Counselor	45599	CA

General Provider Information

NPI Number	:	1427131077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ADINA RACHEL ROSE MFT

Provider Business Mailing Address
First Line	:	916 CERRITO ST
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-1522
Country	:	US
Telephone Number	:	415-225-6896
Fax Number	:

Provider Business Practice Location Address
First Line	:	4980 APPIAN WAY STE 206
Second Line	:
City	:	EL SOBRANTE
State	:	CA
Zip	:	94803-1900
Country	:	US
Telephone Number	:	510-496-6055
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	12/11/2018

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