Provider Demographics
NPI:1457787251
Name:ROSARIO, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3100
Mailing Address - Country:US
Mailing Address - Phone:413-657-1917
Mailing Address - Fax:
Practice Address - Street 1:150 FRONT ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3100
Practice Address - Country:US
Practice Address - Phone:413-657-1917
Practice Address - Fax:413-301-8205
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303295Medicaid
MA1307576Medicaid
MAM18463OtherBLUE CROSS/BLUE SHIELD
MAY10086Medicare PIN