Provider Demographics
NPI:1164987038
Name:ROSADO, JESSICA A (LMSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:ROSADO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 RHINELANDER AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-3430
Mailing Address - Country:US
Mailing Address - Phone:646-671-4731
Mailing Address - Fax:
Practice Address - Street 1:959 RHINELANDER AVE APT 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3430
Practice Address - Country:US
Practice Address - Phone:646-671-4731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105754104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker