Provider Demographics
NPI:1245242593
Name:DAGUE, ROZALIA LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROZALIA
Middle Name:LEE
Last Name:DAGUE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 7TH ST
Mailing Address - Street 2:A
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-6203
Mailing Address - Country:US
Mailing Address - Phone:707-542-1221
Mailing Address - Fax:
Practice Address - Street 1:112 7TH ST
Practice Address - Street 2:A
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-6203
Practice Address - Country:US
Practice Address - Phone:707-542-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS130011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical