Provider Demographics
NPI:1659031516
Name:ROSAS, BREEA MARIE (EDS)
Entity Type:Individual
Prefix:
First Name:BREEA
Middle Name:MARIE
Last Name:ROSAS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1274 N CRESCENT HEIGHTS BLVD APT 244
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5061
Mailing Address - Country:US
Mailing Address - Phone:425-293-6763
Mailing Address - Fax:
Practice Address - Street 1:1274 N CRESCENT HEIGHTS BLVD APT 244
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5061
Practice Address - Country:US
Practice Address - Phone:425-293-6763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool