Healthcare Provider Details

I. General information

NPI: 1306034939
Provider Name (Legal Business Name): LISA CHRISTINE ROSARIO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CHURCH ST FL 5
NEW YORK NY
10013-2904
US

IV. Provider business mailing address

220 CHURCH ST FL 5
NEW YORK NY
10013-2904
US

V. Phone/Fax

Practice location:
  • Phone: 646-619-6699
  • Fax: 646-619-6782
Mailing address:
  • Phone: 646-619-6699
  • Fax: 646-619-6782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number070226
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: