Provider Demographics
NPI:1083870760
Name:ROSE, BEVERLY MANLEY (BEVERLY MANLEY ROSE)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:MANLEY
Last Name:ROSE
Suffix:
Gender:F
Credentials:BEVERLY MANLEY ROSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10845 LINDBROOK DR
Mailing Address - Street 2:207
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3042
Mailing Address - Country:US
Mailing Address - Phone:310-208-4122
Mailing Address - Fax:
Practice Address - Street 1:10845 LINDBROOK DR
Practice Address - Street 2:207
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3042
Practice Address - Country:US
Practice Address - Phone:310-208-4122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACP5261103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist