Provider Demographics
NPI:1598536286
Name:GAMBOA, ROSA JOSEPHINE (LCSW)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:JOSEPHINE
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2127
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-2127
Mailing Address - Country:US
Mailing Address - Phone:970-306-4673
Mailing Address - Fax:
Practice Address - Street 1:151 MILLER RANCH RD
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-6420
Practice Address - Country:US
Practice Address - Phone:970-569-5397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099300311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical