MEDICARE: MISS NOELIA A 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	101YM0800X	Mental Health Counselor	073059	NY

General Provider Information

NPI Number	:	1427211614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NOELIA A ROSADO LCSW

Provider Business Mailing Address
First Line	:	1212 THIERIOT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472-4714
Country	:	US
Telephone Number	:	646-258-9148
Fax Number	:	718-239-7242

Provider Business Practice Location Address
First Line	:	1212 THIERIOT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472-4714
Country	:	US
Telephone Number	:	646-258-9148
Fax Number	:	718-239-7242

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

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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