Provider Demographics
NPI:1013615624
Name:ROSALES, REINA CASSANDRA (MSW)
Entity Type:Individual
Prefix:
First Name:REINA
Middle Name:CASSANDRA
Last Name:ROSALES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3453
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-0946
Mailing Address - Country:US
Mailing Address - Phone:951-500-4742
Mailing Address - Fax:
Practice Address - Street 1:120 S STATE COLLEGE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5837
Practice Address - Country:US
Practice Address - Phone:714-577-5400
Practice Address - Fax:714-577-5450
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW112310104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker