Provider Demographics
NPI:1164116307
Name:ABREU ROSA, JINSELLY
Entity Type:Individual
Prefix:
First Name:JINSELLY
Middle Name:
Last Name:ABREU ROSA
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 1:893 OLD MEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-2660
Mailing Address - Country:US
Mailing Address - Phone:917-640-1729
Mailing Address - Fax:
Practice Address - Street 1:893 OLD MEDFORD AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2660
Practice Address - Country:US
Practice Address - Phone:917-640-1729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor