Provider Demographics
NPI:1144584541
Name:CARRANZA, ROSE ELLEN (MARRIAGE AND FAMILY)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:ELLEN
Last Name:CARRANZA
Suffix:
Gender:F
Credentials:MARRIAGE AND FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20501 VENTURA BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-6258
Mailing Address - Country:US
Mailing Address - Phone:818-657-0411
Mailing Address - Fax:818-657-0406
Practice Address - Street 1:20501 VENTURA BLVD STE 170
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-6258
Practice Address - Country:US
Practice Address - Phone:818-657-0411
Practice Address - Fax:818-657-0406
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2021-01-24
Deactivation Date:2012-10-31
Deactivation Code:
Reactivation Date:2020-02-28
Provider Licenses
StateLicense IDTaxonomies
CA112388106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7068Medicaid
CA6758Medicaid
CA7420Medicaid