Provider Demographics
NPI:1770043440
Name:ROSARIO-MORALES, MERCEDES ANDRIANA (LMT)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:ANDRIANA
Last Name:ROSARIO-MORALES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MERCEDES
Other - Middle Name:ANDRIANA
Other - Last Name:ROSARIO-MORALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:7 SHANNON LN
Mailing Address - Street 2:
Mailing Address - City:ASSONET
Mailing Address - State:MA
Mailing Address - Zip Code:02702-1206
Mailing Address - Country:US
Mailing Address - Phone:508-644-7132
Mailing Address - Fax:
Practice Address - Street 1:65 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ASSONET
Practice Address - State:MA
Practice Address - Zip Code:02702-1015
Practice Address - Country:US
Practice Address - Phone:508-644-1622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15938225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA15938OtherMASSAGE THERAPIST