Provider Demographics
NPI:1164582268
Name:SATTEN, ROSLYN S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSLYN
Middle Name:S
Last Name:SATTEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ROSLYN
Other - Middle Name:S
Other - Last Name:STALZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:32161 ELLISON WAY
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437
Mailing Address - Country:US
Mailing Address - Phone:707-964-1416
Mailing Address - Fax:
Practice Address - Street 1:331 A REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437
Practice Address - Country:US
Practice Address - Phone:707-964-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS176571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32424ZMedicare ID - Type Unspecified