Provider Demographics
NPI:1003930413
Name:CANALES ROSSI, RITHA (LCSW)
Entity type:Individual
Prefix:
First Name:RITHA
Middle Name:
Last Name:CANALES ROSSI
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 1:614 TULLY RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1048
Mailing Address - Country:US
Mailing Address - Phone:408-494-1588
Mailing Address - Fax:
Practice Address - Street 1:614 TULLY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1048
Practice Address - Country:US
Practice Address - Phone:408-494-1561
Practice Address - Fax:408-292-3640
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 210221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGN849ZMedicare PIN
CAGN849WMedicare PIN
CAGN849UMedicare PIN
CAGN849XMedicare PIN
CAGN849SMedicare PIN
Q08104Medicare UPIN
CAGN849YMedicare PIN
CAGN849VMedicare PIN
CAGN849TMedicare PIN