Provider Demographics
NPI:1649630088
Name:ROSARIO, CLARETHA
Entity type:Individual
Prefix:
First Name:CLARETHA
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 1:1611 WHITE CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5449
Mailing Address - Country:US
Mailing Address - Phone:804-690-8177
Mailing Address - Fax:804-745-7183
Practice Address - Street 1:1611 WHITE CEDAR LN
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5449
Practice Address - Country:US
Practice Address - Phone:804-690-8177
Practice Address - Fax:804-745-7183
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-27
Last Update Date:2016-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1324871171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA717M00000XOtherCASE MANAGEMENT - CARE COORDINATOR