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NPI Code Detail

MEDICARE: ROSA I WINTER LCSW

MEDICARE: ROSA I WINTER 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
11041C0700XClinical Social WorkerLCS22924CA

General Provider Information

NPI Number : 1912104076
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSA I WINTER LCSW
Provider Business Mailing Address
First Line : 393 E WALNUT ST
Second Line : 3RD FLOOR - PHR SYSTEMS
City : PASADENA
State : CA
Zip : 91188-0001
Country : US
Telephone Number : 626-405-7914
Fax Number : 626-405-6768
Provider Business Practice Location Address
First Line : 5330 SAN BERNARDINO ST
Second Line :
City : MONTCLAIR
State : CA
Zip : 91763-2952
Country : US
Telephone Number : 909-399-3776
Fax Number : 626-405-6768
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2007
Last Update Date : 08/04/2014

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