Healthcare Provider Details

I. General information

NPI: 1912646696
Provider Name (Legal Business Name): ENRIQUE ROSARIO LCSW 136730
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 M ST
FRESNO CA
93721-1805
US

IV. Provider business mailing address

1393 BAILEY ST
HANFORD CA
93230-5922
US

V. Phone/Fax

Practice location:
  • Phone: 559-706-7428
  • Fax:
Mailing address:
  • Phone: 559-582-4481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number136730
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number113359
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number113359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: