Provider Demographics
NPI:1780841445
Name:ROSE, VICTORIA LAURA (LMFCT)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LAURA
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMFCT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:LAURA
Other - Last Name:FERDINAND-GANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:5201 GREAT AMERICA PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1140
Mailing Address - Country:US
Mailing Address - Phone:323-676-7425
Mailing Address - Fax:
Practice Address - Street 1:5201 GREAT AMERICA PKWY STE 320
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1140
Practice Address - Country:US
Practice Address - Phone:323-676-7425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
68588106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist