Provider Demographics
NPI:1710048632
Name:ROSALES, HECTOR (MASTERS IN SOCIAL WO)
Entity Type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:
Last Name:ROSALES
Suffix:
Gender:M
Credentials:MASTERS IN SOCIAL WO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3918 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-3202
Mailing Address - Country:US
Mailing Address - Phone:718-435-5401
Mailing Address - Fax:718-435-6173
Practice Address - Street 1:3918 7TH AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-3201
Practice Address - Country:US
Practice Address - Phone:718-435-5401
Practice Address - Fax:718-435-6173
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03120911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01730890Medicaid
NY01730890Medicaid