Provider Demographics
NPI:1477065654
Name:ROSADO-SANDOVAL, DIANA (LMSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:ROSADO-SANDOVAL
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 1:50 FAIRVIEW ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-3046
Mailing Address - Country:US
Mailing Address - Phone:718-300-1580
Mailing Address - Fax:
Practice Address - Street 1:50 FAIRVIEW ST APT 1B
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-3046
Practice Address - Country:US
Practice Address - Phone:718-300-1580
Practice Address - Fax:718-300-1580
Is Sole Proprietor?:No
Enumeration Date:2017-10-28
Last Update Date:2017-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078817104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker