Provider Demographics
NPI:1083495535
Name:ROSARIO, CRYSTALINA
Entity Type:Individual
Prefix:
First Name:CRYSTALINA
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CURRITUCK COMMERICAL DR STE A1
Mailing Address - Street 2:
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-9086
Mailing Address - Country:US
Mailing Address - Phone:252-435-1665
Mailing Address - Fax:
Practice Address - Street 1:237 HANBURY RD E STE 17-198
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-6621
Practice Address - Country:US
Practice Address - Phone:252-435-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician