Provider Demographics
NPI:1376284000
Name:CASTRO ROSARIO, IXADARIE
Entity type:Individual
Prefix:
First Name:IXADARIE
Middle Name:
Last Name:CASTRO ROSARIO
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 1:502 LECHNER CIR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08801-3150
Mailing Address - Country:US
Mailing Address - Phone:908-305-0313
Mailing Address - Fax:
Practice Address - Street 1:502 LECHNER CIR
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:NJ
Practice Address - Zip Code:08801-3150
Practice Address - Country:US
Practice Address - Phone:908-305-0313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06661300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker