Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ASW70657 | CA |
Y | 1041C0700X | Clinical Social Worker | LCSW101204 | CA |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1013075050 |
---|---|
Provider Name | Rosa Cantu |
First Address | Los Angeles, CA 90064-1937 |
Second Address | Los Angeles, CA 90064-1937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 21/05/2021 |