Provider Demographics
NPI:1336715184
Name:ROSARIO, JOSE (CASAC, MAC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:CASAC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1015
Mailing Address - Country:US
Mailing Address - Phone:646-759-4673
Mailing Address - Fax:
Practice Address - Street 1:2015 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1015
Practice Address - Country:US
Practice Address - Phone:646-759-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7643OtherSUBSTANCE USE