MEDICARE: MONICA ANGEL ROSADO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	006295	CT
2	1041C0700X	Clinical Social Worker	070476	NY
3	251S00000X	Community/Behavioral Health Agency	070476	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	006295	OTHER	CT	CT STATE LICENSED CLINICAL SOCIAL WORKER ID
2	070476	OTHER	NY	NY STATE LICENSED CLINICAL SOCIAL WORKER ID
3	11645404	OTHER	CT	CAQH
4	14006295CT02	OTHER	CT	ANTHEM PROVIDER #

General Provider Information

NPI Number	:	1013009521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA ANGEL ROSADO LCSW

Provider Business Mailing Address
First Line	:	423 COURTLAND AVE
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06906-1813
Country	:	US
Telephone Number	:	917-518-4713
Fax Number	:	203-324-0212

Provider Business Practice Location Address
First Line	:	423 COURTLAND AVE
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06906-1813
Country	:	US
Telephone Number	:	917-518-4713
Fax Number	:	203-324-0212

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	11/08/2010

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