Provider Demographics
NPI:1447704598
Name:ROSE, ANDREA PAPE (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:PAPE
Last Name:ROSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4346 HILL ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-4117
Mailing Address - Country:US
Mailing Address - Phone:619-417-8811
Mailing Address - Fax:
Practice Address - Street 1:3411 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4906
Practice Address - Country:US
Practice Address - Phone:619-993-3883
Practice Address - Fax:619-330-7124
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical