Provider Demographics
NPI:1134259344
Name:ROSE, ANNE-OLIVIA S (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANNE-OLIVIA
Middle Name:S
Last Name:ROSE
Suffix:
Gender:F
Credentials:PSYD
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 2905
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94979-2905
Mailing Address - Country:US
Mailing Address - Phone:415-758-3726
Mailing Address - Fax:
Practice Address - Street 1:240 TAMAL VISTA BLVD STE 290
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1159
Practice Address - Country:US
Practice Address - Phone:415-758-3726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23097103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical