Provider Demographics
NPI:1093140444
Name:DEL ROSARIO, TINA M (LCSW)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:DEL ROSARIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:ANGULO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 N AVENUE 66
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-2931
Mailing Address - Country:US
Mailing Address - Phone:323-490-0050
Mailing Address - Fax:
Practice Address - Street 1:2550 HONOLULU AVE STE 107
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1859
Practice Address - Country:US
Practice Address - Phone:323-490-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW67392101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health