Provider Demographics
NPI:1962659904
Name:ROSA, ANANDA ENGBER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANANDA
Middle Name:ENGBER
Last Name:ROSA
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 1:221 N EAST AVE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5226
Mailing Address - Country:US
Mailing Address - Phone:479-871-1888
Mailing Address - Fax:
Practice Address - Street 1:221 N EAST AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5226
Practice Address - Country:US
Practice Address - Phone:479-871-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW-1680104100000X
ARLCSW 1952-C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker