Provider Demographics
NPI:1366671257
Name:NIETO, ROSE-MARIE Y (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSE-MARIE
Middle Name:Y
Last Name:NIETO
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 1:3330 HEIGHTS DR STE 120
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-7769
Mailing Address - Country:US
Mailing Address - Phone:530-677-4404
Mailing Address - Fax:530-677-4545
Practice Address - Street 1:3330 HEIGHTS DR STE 120
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682
Practice Address - Country:US
Practice Address - Phone:530-677-4404
Practice Address - Fax:530-677-4545
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS10219101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health