Provider Demographics
NPI:1164820486
Name:CEPEDA, ROSA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:CEPEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 LAS ALTURAS RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2105
Mailing Address - Country:US
Mailing Address - Phone:805-450-3216
Mailing Address - Fax:
Practice Address - Street 1:661 LAS ALTURAS RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2105
Practice Address - Country:US
Practice Address - Phone:805-450-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA80902OtherBOARD OF BEHAVIORAL SCIENCES