Basic Information
| Provider Information | |||||||||
| NPI: | 1700214202 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSSI | ||||||||
| FirstName: | AMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 545 ESTUDILLO AVE | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945774611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103520336 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 MASONIC AVE | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941184415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155678370 | ||||||||
| FaxNumber: | 4153462356 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2013 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 36386 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.