Provider Demographics
NPI:1962682591
Name:ROSARIO, SAMUEL (LICSW)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 OLD STREET RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1265
Mailing Address - Country:US
Mailing Address - Phone:603-924-9490
Mailing Address - Fax:
Practice Address - Street 1:458 OLD STREET RD
Practice Address - Street 2:SUITE 202
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1265
Practice Address - Country:US
Practice Address - Phone:603-924-9490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE161402OtherMEDICARE PTAN
NH30426923Medicaid