Healthcare Provider Details

I. General information

NPI: 1457809121
Provider Name (Legal Business Name): JESSICA ROSADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SYCAMORE ST
WORCESTER MA
01608-2213
US

IV. Provider business mailing address

11 SYCAMORE ST
WORCESTER MA
01608-2213
US

V. Phone/Fax

Practice location:
  • Phone: 508-798-1900
  • Fax: 508-798-1914
Mailing address:
  • Phone: 508-798-1900
  • Fax: 508-798-1914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1316245319
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTT&S / TM FOR MBHP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: