Provider Demographics
NPI:1043510209
Name:LUTRARIO, ROSA
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:LUTRARIO
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 1:759 S VAN NESS AVE
Mailing Address - Street 2:(SECOND FLOOR)
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1908
Mailing Address - Country:US
Mailing Address - Phone:415-642-4550
Mailing Address - Fax:
Practice Address - Street 1:3451 E 12TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-3463
Practice Address - Country:US
Practice Address - Phone:510-535-3700
Practice Address - Fax:510-535-4216
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA689211041C0700X
CAASW33729104100000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor