Provider Demographics
NPI:1023191749
Name:ROSARIO, JOHN (PSYD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:ROSARIO-PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:81 GROZIER RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-3314
Mailing Address - Country:US
Mailing Address - Phone:781-648-2256
Mailing Address - Fax:617-876-1230
Practice Address - Street 1:81 GROZIER RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3314
Practice Address - Country:US
Practice Address - Phone:781-648-2256
Practice Address - Fax:617-876-1230
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7894103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06075OtherBLUECROSS BLUESHIELD
MA0500950Medicaid
MAW50787Medicare ID - Type Unspecified