Provider Demographics
NPI:1588771711
Name:ROSE, BARBARA (MFT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
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 1:870 MARKET ST
Mailing Address - Street 2:SUITE 540
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3099
Mailing Address - Country:US
Mailing Address - Phone:415-373-0192
Mailing Address - Fax:415-373-0192
Practice Address - Street 1:870 MARKET ST
Practice Address - Street 2:SUITE 540
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3099
Practice Address - Country:US
Practice Address - Phone:415-373-0192
Practice Address - Fax:415-373-0192
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2014-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41113106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA251819OtherCOMPSYCH CHICAGO, IL
CAMFT 411130OtherBLUE SHIELD