Provider Demographics
NPI:1629472691
Name:CLAUDIO ROSA, ANAIDY (LSCSW, LCAC)
Entity Type:Individual
Prefix:
First Name:ANAIDY
Middle Name:
Last Name:CLAUDIO ROSA
Suffix:
Gender:F
Credentials:LSCSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 W VILLAGE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-2612
Mailing Address - Country:US
Mailing Address - Phone:316-284-7730
Mailing Address - Fax:
Practice Address - Street 1:300 W DOUGLAS AVE STE 205
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2904
Practice Address - Country:US
Practice Address - Phone:316-553-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW 9407104100000X
KS48001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker