Provider Demographics
NPI:1306155247
Name:ROSARIO, KELLY ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 SEAVIEW AVE
Mailing Address - Street 2:BLDG 10, OVL CLINIC
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3409
Mailing Address - Country:US
Mailing Address - Phone:718-667-2335
Mailing Address - Fax:718-667-2783
Practice Address - Street 1:777 SEAVIEW AVE
Practice Address - Street 2:BLDG 10, OVL CLINIC
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3409
Practice Address - Country:US
Practice Address - Phone:718-667-2335
Practice Address - Fax:718-667-2783
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073816-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker