Provider Demographics
NPI:1497442388
Name:ROSARIO, DARLENE JOY
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:JOY
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:PO BOX 20473
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30325-0473
Mailing Address - Country:US
Mailing Address - Phone:619-775-9515
Mailing Address - Fax:
Practice Address - Street 1:3750 PALLADIAN VILLAGE DR STE 320
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-8204
Practice Address - Country:US
Practice Address - Phone:619-775-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health