Provider Demographics
NPI:1902141559
Name:ROSADO, RODOLFO JOSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:JOSE
Last Name:ROSADO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:RODOLFO
Other - Middle Name:JOSE
Other - Last Name:ROSADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1065 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-2417
Mailing Address - Country:US
Mailing Address - Phone:718-589-7440
Mailing Address - Fax:
Practice Address - Street 1:1065 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-2417
Practice Address - Country:US
Practice Address - Phone:203-984-6768
Practice Address - Fax:203-846-4109
Is Sole Proprietor?:No
Enumeration Date:2012-12-09
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001841103T00000X
NY011837103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist