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General NPI Number Information
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NPI Number | 1972160158
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Entity Type | Individual
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Provider Name | ELIZABETH ROSARIO LSW, ICDVP
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Gender | Female
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 3249 N CENTRAL AVE
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City | CHICAGO
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State | IL
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Zip | 60634-4360
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Country | US
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Telephone | 773-371-3742
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Fax |
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Provider Business Mailing Address
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Address Line | 5148 N AVERS AVE APT 1E
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City | CHICAGO
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State | IL
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Zip | 60625-6038
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 150102785
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149021370
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License Number State | IL
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