MEDICARE: DR. GEORGE WILLIAM ROSCH III PH.D., 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

General Provider Information

NPI Number	:	1881780500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE WILLIAM ROSCH III PH.D., LCSW

Provider Business Mailing Address
First Line	:	885 BURLINGTON STREET
Second Line	:
City	:	FILLMORE
State	:	CA
Zip	:	93015-1848
Country	:	US
Telephone Number	:	805-524-1769
Fax Number	:	805-524-2053

Provider Business Practice Location Address
First Line	:	3585 MAPLE STREET
Second Line	:	SUITE 205
City	:	VENTURA
State	:	CA
Zip	:	93003-3504
Country	:	US
Telephone Number	:	805-524-1769
Fax Number	:	805-524-2053

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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