Provider Demographics
NPI:1548017528
Name:ROSARIO, OLGA LUCIA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:LUCIA
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 1:1326 128TH ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1900
Mailing Address - Country:US
Mailing Address - Phone:718-269-9806
Mailing Address - Fax:
Practice Address - Street 1:1326 128TH ST APT 1B
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-1900
Practice Address - Country:US
Practice Address - Phone:718-269-9806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY112423-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker