Provider Demographics
NPI:1376614941
Name:DEL ROSARIO, INGEBORG V
Entity Type:Individual
Prefix:
First Name:INGEBORG
Middle Name:V
Last Name:DEL 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 1:4119 41ST ST
Mailing Address - Street 2:APT. 6D
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3258
Mailing Address - Country:US
Mailing Address - Phone:347-251-3919
Mailing Address - Fax:
Practice Address - Street 1:4119 41ST ST
Practice Address - Street 2:APT. 6D
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-3258
Practice Address - Country:US
Practice Address - Phone:347-251-3919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000598103TP0814X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral