Provider Demographics
NPI:1326107731
Name:MILES, ROSEMARY CLAIRE (LMFT LIC MARRIAGE FA)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:CLAIRE
Last Name:MILES
Suffix:
Gender:F
Credentials:LMFT LIC MARRIAGE FA
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:CLAIRE
Other - Last Name:DI PIETRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1627 OAK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1072
Mailing Address - Country:US
Mailing Address - Phone:530-756-0555
Mailing Address - Fax:530-756-1368
Practice Address - Street 1:1627 OAK AVE STE A
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1072
Practice Address - Country:US
Practice Address - Phone:530-756-0555
Practice Address - Fax:530-756-1368
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23272103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical