Provider Demographics
NPI:1568958528
Name:JUSUE, ROSA MARIA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIA
Last Name:JUSUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39155 LIBERTY ST STE G710
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1525
Mailing Address - Country:US
Mailing Address - Phone:510-795-2441
Mailing Address - Fax:510-574-2001
Practice Address - Street 1:39155 LIBERTY ST STE G710
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1525
Practice Address - Country:US
Practice Address - Phone:510-449-4332
Practice Address - Fax:510-793-3972
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1098461041C0700X
CAASW909511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical