Provider Demographics
NPI:1366004079
Name:ROSAS, SEAN A (LCSW)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:A
Last Name:ROSAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12383 MAYS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:GUERNEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95446
Mailing Address - Country:US
Mailing Address - Phone:707-604-1400
Mailing Address - Fax:707-922-5005
Practice Address - Street 1:12383 MAYS CANYON RD
Practice Address - Street 2:
Practice Address - City:GUERNEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95446
Practice Address - Country:US
Practice Address - Phone:707-604-1400
Practice Address - Fax:707-922-5005
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1260871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty