Provider Demographics
NPI:1528775350
Name:NEIDHARDT, ROSA ESTHER
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:ESTHER
Last Name:NEIDHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14632 YORBA ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2554
Mailing Address - Country:US
Mailing Address - Phone:714-714-0780
Mailing Address - Fax:
Practice Address - Street 1:14632 YORBA ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2554
Practice Address - Country:US
Practice Address - Phone:714-714-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110525104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker