Provider Demographics
NPI:1801145255
Name:JOSHUA ROSE LICENSED CLINICAL SOCIAL WORKER INC.
Entity type:Organization
Organization Name:JOSHUA ROSE LICENSED CLINICAL SOCIAL WORKER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:510-734-7028
Mailing Address - Street 1:2413 BROWNING ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2026
Mailing Address - Country:US
Mailing Address - Phone:510-734-7028
Mailing Address - Fax:
Practice Address - Street 1:428 WILSON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2305
Practice Address - Country:US
Practice Address - Phone:510-734-7028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26688251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health