Provider Demographics
NPI:1124837349
Name:CARR, ROSE (AMFT)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1211
Mailing Address - Country:US
Mailing Address - Phone:415-308-9729
Mailing Address - Fax:
Practice Address - Street 1:182 SAN GERONIMO VALLEY DR.
Practice Address - Street 2:
Practice Address - City:WOODACRE
Practice Address - State:CA
Practice Address - Zip Code:94973
Practice Address - Country:US
Practice Address - Phone:415-488-0454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA151168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist