Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003228347 |
---|---|
Provider Name | Iris Rosario |
First Address | Holyoke, MA 01040-6513 |
Second Address | Holyoke, MA 01040-6513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2014 |
Last Update Date | 21/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1303295 | (05) | MA |
1307576 | (05) | MA |
M18463 | BLUE CROSS BLUE SHIELD (01) | MA |