Provider Demographics
NPI:1700364155
Name:PALOS KESSLER, ROSE MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
Last Name:PALOS KESSLER
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 1:699 SERRAMONTE BLVD
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4132
Mailing Address - Country:US
Mailing Address - Phone:650-755-5143
Mailing Address - Fax:
Practice Address - Street 1:699 SERRAMONTE BLVD
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4132
Practice Address - Country:US
Practice Address - Phone:650-755-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-29
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23639101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty