Provider Demographics
NPI:1699227371
Name:KING ROUSE, ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:KING ROUSE
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 1:1970 BROADWAY
Mailing Address - Street 2:835
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2234
Mailing Address - Country:US
Mailing Address - Phone:510-541-0889
Mailing Address - Fax:
Practice Address - Street 1:1970 BROADWAY
Practice Address - Street 2:835
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2234
Practice Address - Country:US
Practice Address - Phone:510-541-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSWSW654671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical