Provider Demographics
NPI:1912666843
Name:BLASI, ROSA (LMFT)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:BLASI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:
Other - Last Name:BLASI-HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:6952 W 77TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6952 W 77TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1077
Practice Address - Country:US
Practice Address - Phone:310-493-1218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129195106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist