Provider Demographics
NPI:1740421908
Name:SELIGSON, ROSE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:
Last Name:SELIGSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:256 CALLE ARAGON
Mailing Address - Street 2:UNIT 'O'
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637
Mailing Address - Country:US
Mailing Address - Phone:949-598-0855
Mailing Address - Fax:
Practice Address - Street 1:256 CALLE ARAGON
Practice Address - Street 2:UNIT 'O'
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637
Practice Address - Country:US
Practice Address - Phone:949-598-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA#L54721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical