Provider Demographics
NPI:1104668839
Name:ESSENTIA TELEHEALTH AND WELLNESS
Entity type:Organization
Organization Name:ESSENTIA TELEHEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:505-365-1519
Mailing Address - Street 1:110 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1333
Mailing Address - Country:US
Mailing Address - Phone:505-365-1519
Mailing Address - Fax:315-637-8557
Practice Address - Street 1:110 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1333
Practice Address - Country:US
Practice Address - Phone:505-365-1519
Practice Address - Fax:315-637-8557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical