Healthcare Provider Details

I. General information

NPI: 1790605731
Provider Name (Legal Business Name): JASMALY MARIE ROSADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1158 SPRINGFIELD ST, FEEDING HILLS, MA
FEEDING HILLS MA
01030
US

IV. Provider business mailing address

1158 SPRINGFIELD ST, FEEDING HILLS, MA
FEEDING HILLS MA
01030
US

V. Phone/Fax

Practice location:
  • Phone: 877-418-2978
  • Fax: 866-500-2186
Mailing address:
  • Phone: 877-418-2978
  • Fax: 866-500-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: