Provider Demographics
NPI:1093169161
Name:INSIGHT FOR WELLNESS
Entity Type:Organization
Organization Name:INSIGHT FOR WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD
Authorized Official - Phone:925-216-3510
Mailing Address - Street 1:2821 CROW CANYON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1659
Mailing Address - Country:US
Mailing Address - Phone:925-216-3510
Mailing Address - Fax:
Practice Address - Street 1:2821 CROW CANYON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1659
Practice Address - Country:US
Practice Address - Phone:925-216-3510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSIGHT FOR WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-14
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS189531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ15994ZMedicare PIN