Provider Demographics
NPI:1528149861
Name:ROSE, LINDA G (LCSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:G
Last Name:ROSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 RANDALL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2751
Mailing Address - Country:US
Mailing Address - Phone:415-643-3996
Mailing Address - Fax:415-643-0982
Practice Address - Street 1:278 RANDALL ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2751
Practice Address - Country:US
Practice Address - Phone:415-643-3996
Practice Address - Fax:415-643-0982
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS#150261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13216ZMedicare ID - Type Unspecified