Provider Demographics
NPI:1154406262
Name:ROSADO, JOSET MICHELE (LISW)
Entity type:Individual
Prefix:MRS
First Name:JOSET
Middle Name:MICHELE
Last Name:ROSADO
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 CENTRAL AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-9386
Mailing Address - Country:US
Mailing Address - Phone:646-739-1789
Mailing Address - Fax:
Practice Address - Street 1:820 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-3743
Practice Address - Country:US
Practice Address - Phone:843-410-9234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC98821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002954Medicare UPIN
NYNE3421Medicare UPIN