Provider Demographics
NPI:1689078594
Name:ROSADO, JACQUELINE
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:ROSADO
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 1:15009 CALLE UCAR
Mailing Address - Street 2:PASEOS DE JACARANDA
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-9600
Mailing Address - Country:US
Mailing Address - Phone:787-423-7515
Mailing Address - Fax:
Practice Address - Street 1:COMUNIDAD CRISTINA
Practice Address - Street 2:3 CALLE LAS GLADIOLAS
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-9998
Practice Address - Country:US
Practice Address - Phone:939-731-3024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1757103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1757OtherLICENSE