Provider Demographics
NPI:1881744654
Name:ROSALES-WYMAN, CAROLINA IVETTE (LCSW)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:IVETTE
Last Name:ROSALES-WYMAN
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:PO BOX 9380
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94912-9380
Mailing Address - Country:US
Mailing Address - Phone:510-832-2574
Mailing Address - Fax:510-832-2562
Practice Address - Street 1:1904 FRANKLIN ST
Practice Address - Street 2:SUITE #703
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2912
Practice Address - Country:US
Practice Address - Phone:510-832-2574
Practice Address - Fax:510-832-2562
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 228151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU258ZMedicare PIN