Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003220443 |
---|---|
Provider Name | Ivan Rosario |
First Address | Springfield, MA 01103 |
Second Address | Springfield, MA 01103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2014 |
Last Update Date | 13/06/2014 |