Provider Demographics
NPI:1982720835
Name:KITCHEN, ROSA (MFT)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25777 MT CHARLIE RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95033
Mailing Address - Country:US
Mailing Address - Phone:831-438-0880
Mailing Address - Fax:831-461-9325
Practice Address - Street 1:4113 SCOTTS VALLEY DR STE 205
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4547
Practice Address - Country:US
Practice Address - Phone:831-254-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT35854106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46885OtherMANAGED HEALTH NETWORK
CA119242OtherSANTA CRUZ COUNTY
CA1622-01OtherMEDICAL