MEDICARE: JUDY L ROSE LCSW

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	LCSW24551	CA

General Provider Information

NPI Number	:	1639228588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY L ROSE LCSW

Provider Business Mailing Address
First Line	:	4635 CAMDEN ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94619-2639
Country	:	US
Telephone Number	:	415-887-8273
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 SANTA CLARA AVE STE 106
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4667
Country	:	US
Telephone Number	:	510-842-8647
Fax Number	:	510-866-2274

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	08/27/2019

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