1144406463 NPI number — MRS. STEPHANIE LEE ROSEN L.C.S.W.

Table of content: MRS. STEPHANIE LEE ROSEN L.C.S.W. (NPI 1144406463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144406463 NPI number — MRS. STEPHANIE LEE ROSEN L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSEN
Provider First Name:
STEPHANIE
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEE
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
KIRSTY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.C.S.W.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144406463
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2351 CARDINAL LN
Provider Second Line Business Mailing Address:
ANNEX B
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-3743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-573-2227
Provider Business Mailing Address Fax Number:
858-496-2113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2351 CARDINAL LN
Provider Second Line Business Practice Location Address:
ANNEX B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-3743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-573-2227
Provider Business Practice Location Address Fax Number:
858-496-2113
Provider Enumeration Date:
01/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS18735 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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