Provider Demographics
NPI:1124381173
Name:VANRIEL, ROSAURA (MS IN SPECIAL EDUC)
Entity Type:Individual
Prefix:MRS
First Name:ROSAURA
Middle Name:
Last Name:VANRIEL
Suffix:
Gender:F
Credentials:MS IN SPECIAL EDUC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 EAST 69 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:347-884-3544
Mailing Address - Fax:347-523-3941
Practice Address - Street 1:3736 HENRY HUDSON PARKWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:134-752-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY745222971174400000X, 261QM0855X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No174400000XOther Service ProvidersSpecialist
No252Y00000XAgenciesEarly Intervention Provider Agency