Provider Demographics
NPI:1356648976
Name:TRIVINO-PEREZ, ROSANA ISABEL (LCSW)
Entity Type:Individual
Prefix:
First Name:ROSANA
Middle Name:ISABEL
Last Name:TRIVINO-PEREZ
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 1:10940 WILSHIRE BLVD
Mailing Address - Street 2:16TH FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3915
Mailing Address - Country:US
Mailing Address - Phone:310-709-8892
Mailing Address - Fax:
Practice Address - Street 1:10940 WILSHIRE BLVD
Practice Address - Street 2:16TH FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3915
Practice Address - Country:US
Practice Address - Phone:310-709-8892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA263551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical