Provider Demographics
NPI:1932409125
Name:RO, CHRISTINA (LCSW 67046)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:RO
Suffix:
Gender:F
Credentials:LCSW 67046
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 SAN FERNANDO RD APT 1413
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2865
Mailing Address - Country:US
Mailing Address - Phone:213-760-3410
Mailing Address - Fax:
Practice Address - Street 1:5110 W GOLDLEAF CIR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90056-1282
Practice Address - Country:US
Practice Address - Phone:323-290-8562
Practice Address - Fax:323-290-3180
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA670461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical