Provider Demographics
NPI:1457097099
Name:ANDREA P. ROSE, LICENSED CLINICAL SOCIAL WORKER, INC.
Entity Type:Organization
Organization Name:ANDREA P. ROSE, LICENSED CLINICAL SOCIAL WORKER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:619-993-3883
Mailing Address - Street 1:4346 HILL ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-4117
Mailing Address - Country:US
Mailing Address - Phone:619-417-8811
Mailing Address - Fax:
Practice Address - Street 1:3411 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4906
Practice Address - Country:US
Practice Address - Phone:619-993-3883
Practice Address - Fax:619-330-7124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty