Provider Demographics
NPI:1477207033
Name:LEON HERNANDEZ, ROSA A (LCSW)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:A
Last Name:LEON HERNANDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:A
Other - Last Name:LEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:570 BLOSSOM HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3212
Mailing Address - Country:US
Mailing Address - Phone:855-799-4647
Mailing Address - Fax:
Practice Address - Street 1:570 BLOSSOM HILL RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3212
Practice Address - Country:US
Practice Address - Phone:855-799-4647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA935801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical