Provider Demographics
NPI:1740524750
Name:ROSAS, AMY ITZEL (LCSW 87185)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ITZEL
Last Name:ROSAS
Suffix:
Gender:F
Credentials:LCSW 87185
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32555 DEER HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-1283
Mailing Address - Country:US
Mailing Address - Phone:951-294-6450
Mailing Address - Fax:
Practice Address - Street 1:32555 DEER HOLLOW WAY
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-1283
Practice Address - Country:US
Practice Address - Phone:951-294-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW871851041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical