Provider Demographics
NPI:1124340831
Name:PENA, ROSAMARI (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROSAMARI
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CAPARRA TOWN PARK # C-14
Mailing Address - Street 2:#16 CALLE LUHN
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-6400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:607 AVE CONDADO
Practice Address - Street 2:COND. CONDADO STE. 401
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907-3845
Practice Address - Country:US
Practice Address - Phone:787-361-9205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3618103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist