Provider Demographics
NPI:1700330222
Name:GANZER, CHARLEE ROSE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHARLEE
Middle Name:ROSE
Last Name:GANZER
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 1:28 HANOVER LN STE B
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7267
Mailing Address - Country:US
Mailing Address - Phone:530-433-4511
Mailing Address - Fax:530-230-2814
Practice Address - Street 1:28 HANOVER LN
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7267
Practice Address - Country:US
Practice Address - Phone:530-433-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA715791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical