Provider Demographics
NPI:1265022396
Name:ROSARIO, ALISA BETH
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:BETH
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 1:7356 ARBOR TRL APT 103
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1598
Mailing Address - Country:US
Mailing Address - Phone:248-795-5571
Mailing Address - Fax:
Practice Address - Street 1:7356 ARBOR TRL APT 103
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1598
Practice Address - Country:US
Practice Address - Phone:248-795-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451019033101Y00000X
MI6401223225101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor