Provider Demographics
NPI:1467709667
Name:ALTAMIRANO, ROSEMOND CAROL (MS)
Entity Type:Individual
Prefix:MS
First Name:ROSEMOND
Middle Name:CAROL
Last Name:ALTAMIRANO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 E 18TH ST
Mailing Address - Street 2:APT7F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7555
Mailing Address - Country:US
Mailing Address - Phone:646-696-0774
Mailing Address - Fax:
Practice Address - Street 1:1333 E 18TH ST
Practice Address - Street 2:APT7F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7555
Practice Address - Country:US
Practice Address - Phone:646-696-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263214252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency