Provider Demographics
NPI:1245396118
Name:ROSARIO, HECTOR LUIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:LUIS
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MAPLE ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-2203
Mailing Address - Country:US
Mailing Address - Phone:413-732-4848
Mailing Address - Fax:413-732-5353
Practice Address - Street 1:120 MAPLE ST
Practice Address - Street 2:SUITE 401
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2203
Practice Address - Country:US
Practice Address - Phone:413-732-4848
Practice Address - Fax:413-732-5353
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1065791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1858823Medicaid
MA1858823Medicaid
MAP04215Medicare ID - Type UnspecifiedIDENTIFICATION NUMBER