Provider Demographics
NPI:1598164832
Name:ANDERSEN, ROSA YVONNE (LMFT)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:YVONNE
Last Name:ANDERSEN
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 1:1090 OLEANDER AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2529
Mailing Address - Country:US
Mailing Address - Phone:196-852-4259
Mailing Address - Fax:
Practice Address - Street 1:750 PACIFIC HIGHWAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92132-1146
Practice Address - Country:US
Practice Address - Phone:619-985-2889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99200106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist