Provider Demographics
NPI:1376653592
Name:REIWITCH, ROSE L (MFT)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:L
Last Name:REIWITCH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2104
Mailing Address - Country:US
Mailing Address - Phone:916-485-4555
Mailing Address - Fax:916-483-3978
Practice Address - Street 1:1713 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2104
Practice Address - Country:US
Practice Address - Phone:916-485-4555
Practice Address - Fax:916-483-3978
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 20972106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist