Provider Demographics
NPI:1427131077
Name:ROSE, ADINA RACHEL (MFT)
Entity type:Individual
Prefix:MRS
First Name:ADINA
Middle Name:RACHEL
Last Name:ROSE
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 1:916 CERRITO ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1522
Mailing Address - Country:US
Mailing Address - Phone:415-225-6896
Mailing Address - Fax:
Practice Address - Street 1:4980 APPIAN WAY STE 206
Practice Address - Street 2:
Practice Address - City:EL SOBRANTE
Practice Address - State:CA
Practice Address - Zip Code:94803-1900
Practice Address - Country:US
Practice Address - Phone:510-496-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45599101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health