Healthcare Provider Details

I. General information

NPI: 1033055249
Provider Name (Legal Business Name): MARY LILLIAN ROSARIO LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N JAMES RD # 1A290
COLUMBUS OH
43219-1834
US

IV. Provider business mailing address

420 N JAMES RD # 1A290
COLUMBUS OH
43219-1834
US

V. Phone/Fax

Practice location:
  • Phone: 614-893-1895
  • Fax:
Mailing address:
  • Phone: 614-893-1895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2513315
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: