Provider Demographics
NPI:1114589462
Name:ROSEWOOD, ALTHEA (LMSW)
Entity Type:Individual
Prefix:
First Name:ALTHEA
Middle Name:
Last Name:ROSEWOOD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 N WILMOT RD # 225
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4410
Mailing Address - Country:US
Mailing Address - Phone:520-271-1923
Mailing Address - Fax:
Practice Address - Street 1:1014 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-4239
Practice Address - Country:US
Practice Address - Phone:520-303-1697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-07
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-15580104100000X
AZLMSW-15880104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLMSW-15880OtherARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS