Provider Demographics
NPI:1780912931
Name:GOMPERTS, ROSAN (LCSW)
Entity type:Individual
Prefix:
First Name:ROSAN
Middle Name:
Last Name:GOMPERTS
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 1:585 CAPISTRANO WAY
Mailing Address - Street 2:MARIPOSA HOUSE
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-8550
Mailing Address - Country:US
Mailing Address - Phone:650-723-4577
Mailing Address - Fax:
Practice Address - Street 1:585 CAPISTRANO WAY
Practice Address - Street 2:MARIPOSA HOUSE
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-8550
Practice Address - Country:US
Practice Address - Phone:650-723-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical