Provider Demographics
NPI:1619329364
Name:ROSADO MARTINEZ, EVELIZ (CRC)
Entity Type:Individual
Prefix:
First Name:EVELIZ
Middle Name:
Last Name:ROSADO MARTINEZ
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 SOUTHERN BLVD RM 301
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3428
Mailing Address - Country:US
Mailing Address - Phone:718-860-2994
Mailing Address - Fax:718-860-4479
Practice Address - Street 1:953 SOUTHERN BLVD RM 301
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3428
Practice Address - Country:US
Practice Address - Phone:718-860-2994
Practice Address - Fax:718-860-4479
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00148316101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor