Provider Demographics
NPI:1811077506
Name:ROSE, AVA FRANCESCA (LCSW)
Entity type:Individual
Prefix:MS
First Name:AVA
Middle Name:FRANCESCA
Last Name:ROSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:
Other - Last Name:ROSE FRIEDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:610 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1632
Mailing Address - Country:US
Mailing Address - Phone:310-205-2661
Mailing Address - Fax:
Practice Address - Street 1:610 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1632
Practice Address - Country:US
Practice Address - Phone:310-205-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS216921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical