Provider Demographics
NPI:1184499220
Name:ROSARIO, MATTHEW MANEUL (LMHP-R, CSAC, CSOTP)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:MANEUL
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:LMHP-R, CSAC, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 BROOK RD STE B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-1801
Mailing Address - Country:US
Mailing Address - Phone:804-446-4444
Mailing Address - Fax:
Practice Address - Street 1:1605 BROOK RD STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-1801
Practice Address - Country:US
Practice Address - Phone:804-446-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016523101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health