Provider Demographics
NPI:1013009521
Name:ROSADO, MONICA ANGEL (LCSW)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ANGEL
Last Name:ROSADO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 COURTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906-1813
Mailing Address - Country:US
Mailing Address - Phone:917-518-4713
Mailing Address - Fax:203-324-0212
Practice Address - Street 1:423 COURTLAND AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06906-1813
Practice Address - Country:US
Practice Address - Phone:917-518-4713
Practice Address - Fax:203-324-0212
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0062951041C0700X
NY0704761041C0700X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006295OtherCT STATE LICENSED CLINICAL SOCIAL WORKER ID
NY070476OtherNY STATE LICENSED CLINICAL SOCIAL WORKER ID
CT11645404OtherCAQH
CT14006295CT02OtherANTHEM PROVIDER #