Provider Demographics
NPI:1225892441
Name:DATARIO, MARYROSE I
Entity type:Individual
Prefix:
First Name:MARYROSE
Middle Name:I
Last Name:DATARIO
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 1:202 ROCHELLE ST
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:NE
Mailing Address - Zip Code:68937-5664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 ROCHELLE ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:NE
Practice Address - Zip Code:68937-5664
Practice Address - Country:US
Practice Address - Phone:308-651-0784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician