Provider Demographics
NPI:1902171291
Name:ROSARIO, KEVIN GEORGE
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:GEORGE
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N FRONT ST
Mailing Address - Street 2:3FL
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-7350
Mailing Address - Country:US
Mailing Address - Phone:774-628-1062
Mailing Address - Fax:
Practice Address - Street 1:100 N FRONT ST
Practice Address - Street 2:3FL
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-7350
Practice Address - Country:US
Practice Address - Phone:774-628-1062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator