Provider Demographics
NPI:1457630873
Name:SMITH, ROSALIE
Entity Type:Individual
Prefix:MRS
First Name:ROSALIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSALIE
Other - Middle Name:
Other - Last Name:BERGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1046 N ABBOTT AVE
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-2933
Mailing Address - Country:US
Mailing Address - Phone:408-766-0265
Mailing Address - Fax:
Practice Address - Street 1:1515 PARTRIDGE AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-4952
Practice Address - Country:US
Practice Address - Phone:408-716-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist