Provider Demographics
NPI:1598009631
Name:ROSARIO, SELENE (SLP, CCC)
Entity Type:Individual
Prefix:MISS
First Name:SELENE
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 PARK HILL DR
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JCT
Mailing Address - State:NY
Mailing Address - Zip Code:12533-5605
Mailing Address - Country:US
Mailing Address - Phone:845-453-9377
Mailing Address - Fax:845-897-4933
Practice Address - Street 1:1133 PLEASANTVILLE RD
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1634
Practice Address - Country:US
Practice Address - Phone:914-241-2727
Practice Address - Fax:914-243-9357
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58 022415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist