Provider Demographics
NPI:1841218823
Name:ROSE, CAMILLE MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:MARIE
Last Name:ROSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:MARIE
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4025 CAMINO DEL RIO S STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4108
Mailing Address - Country:US
Mailing Address - Phone:619-339-4465
Mailing Address - Fax:619-542-7715
Practice Address - Street 1:4025 CAMINO DEL RIO S STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4108
Practice Address - Country:US
Practice Address - Phone:619-339-4465
Practice Address - Fax:619-542-7715
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA202231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical