Provider Demographics
NPI:1437944139
Name:AMARAL, ROSEMARY MIMI MARIE
Entity type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:MIMI MARIE
Last Name:AMARAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4361 TELLER AVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:NEW PORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:718-788-7949
Mailing Address - Fax:
Practice Address - Street 1:720 PETALUMA BLVD S APT 52
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-5149
Practice Address - Country:US
Practice Address - Phone:707-338-3863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-12
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94027138103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist