MEDICARE: HALEY MARIE ROSARIO MSW

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

General Provider Information

NPI Number	:	1437759073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY MARIE ROSARIO MSW

Provider Business Mailing Address
First Line	:	6535 SAM HOUSTON LOOP APT D
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80902-4723
Country	:	US
Telephone Number	:	913-617-7019
Fax Number	:

Provider Business Practice Location Address
First Line	:	6535 SAM HOUSTON LOOP APT D
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80902-4723
Country	:	US
Telephone Number	:	913-617-7019
Fax Number	:

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

Provider Enumeration Date	:	10/30/2020
Last Update Date	:	10/30/2020

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