Provider Demographics
NPI:1083863559
Name:UCSD DEPT. OF PSYCHIATRY
Entity type:Organization
Organization Name:UCSD DEPT. OF PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:619-497-6653
Mailing Address - Street 1:140 ARBOR DR # MC0851
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2007
Mailing Address - Country:US
Mailing Address - Phone:619-497-6647
Mailing Address - Fax:
Practice Address - Street 1:140 ARBOR DR # MC0851
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2007
Practice Address - Country:US
Practice Address - Phone:619-497-6647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health