Provider Demographics
NPI:1689441214
Name:GITTELL, ROSE HOFFER (MA)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:HOFFER
Last Name:GITTELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 SPENCER AVE
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2051
Mailing Address - Country:US
Mailing Address - Phone:603-498-2658
Mailing Address - Fax:
Practice Address - Street 1:136 SPENCER AVE
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2051
Practice Address - Country:US
Practice Address - Phone:604-498-2658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH18-P119986-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health