Provider Demographics
NPI:1194614875
Name:ROSARIO, GENESIS MARIE (MPSY)
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:MARIE
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:MPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 CALLE RIO YAGUEZ
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-4445
Mailing Address - Country:US
Mailing Address - Phone:787-373-8883
Mailing Address - Fax:
Practice Address - Street 1:CALLE FONT MARTELO
Practice Address - Street 2:CENTRO COMERCIAL LOCAL 6 B
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-373-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6900103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling