Provider Demographics
NPI:1184662603
Name:ROSELAREN, HEATHER MCLAREN (LCSW/MPH)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MCLAREN
Last Name:ROSELAREN
Suffix:
Gender:F
Credentials:LCSW/MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 BONITA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1014
Mailing Address - Country:US
Mailing Address - Phone:510-527-1217
Mailing Address - Fax:
Practice Address - Street 1:1918 BONITA AVE STE 200
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1014
Practice Address - Country:US
Practice Address - Phone:510-527-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS140381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA152219OtherMANAGED HEALTH NETWORK
CA200152681OtherBLUE CROSS PROVIDER #