Provider Demographics
NPI:1447066741
Name:CARABALLO, ROSETTA FAITHE
Entity type:Individual
Prefix:DR
First Name:ROSETTA
Middle Name:FAITHE
Last Name:CARABALLO
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 1:2106 UNION ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-8320
Mailing Address - Country:US
Mailing Address - Phone:516-782-9116
Mailing Address - Fax:
Practice Address - Street 1:1701 E WOODFIELD RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5905
Practice Address - Country:US
Practice Address - Phone:224-269-4549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150115600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker