Provider Demographics
NPI:1619743499
Name:ROSEN, LILIANA LEAH
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:LEAH
Last Name:ROSEN
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 1:1410 GUERNEVILLE RD STE 14
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-4172
Mailing Address - Country:US
Mailing Address - Phone:707-795-4336
Mailing Address - Fax:
Practice Address - Street 1:420 E COTATI AVE
Practice Address - Street 2:
Practice Address - City:COTATI
Practice Address - State:CA
Practice Address - Zip Code:94931-4442
Practice Address - Country:US
Practice Address - Phone:707-795-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor