Provider Demographics
NPI:1508157868
Name:ROSENGREN, PAISLEY TUCKER (LMFT)
Entity Type:Individual
Prefix:
First Name:PAISLEY
Middle Name:TUCKER
Last Name:ROSENGREN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4432
Mailing Address - Country:US
Mailing Address - Phone:707-334-8157
Mailing Address - Fax:
Practice Address - Street 1:631 TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4432
Practice Address - Country:US
Practice Address - Phone:707-334-8157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44164106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist