Provider Demographics
NPI:1780740761
Name:ROHRLICK, RICHARD ALAN (MSW, LCSW, BCD, ACSW)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALAN
Last Name:ROHRLICK
Suffix:
Gender:M
Credentials:MSW, LCSW, BCD, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N DOWNS ST
Mailing Address - Street 2:STE. I
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3300
Mailing Address - Country:US
Mailing Address - Phone:760-375-0348
Mailing Address - Fax:760-375-9818
Practice Address - Street 1:801 N DOWNS ST
Practice Address - Street 2:STE. I
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3300
Practice Address - Country:US
Practice Address - Phone:760-375-0348
Practice Address - Fax:760-375-9818
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW #LCS-76341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW #LCS-7634OtherLIC. CLIN. SOC. WORKER #
CALCSW #LCS-7634OtherLIC. CLIN. SOC. WORKER #
CAP16728Medicare UPIN