Provider Demographics
NPI:1861738908
Name:RUNNALLS, ROSALEEN MARGARET (LCSW)
Entity type:Individual
Prefix:
First Name:ROSALEEN
Middle Name:MARGARET
Last Name:RUNNALLS
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 1:119 E GOODWIN ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-3940
Mailing Address - Country:US
Mailing Address - Phone:928-420-2786
Mailing Address - Fax:
Practice Address - Street 1:119 E GOODWIN ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-3940
Practice Address - Country:US
Practice Address - Phone:928-420-2786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-120311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical