Provider Demographics
NPI:1215060660
Name:ROSADO, MAYRA DEL CARMEN (PHD)
Entity type:Individual
Prefix:DR
First Name:MAYRA
Middle Name:DEL CARMEN
Last Name:ROSADO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 CALLE MEDITACION
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4819
Mailing Address - Country:US
Mailing Address - Phone:787-834-1878
Mailing Address - Fax:787-834-1878
Practice Address - Street 1:52 CALLE MEDITACION
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4819
Practice Address - Country:US
Practice Address - Phone:787-834-1878
Practice Address - Fax:787-834-1878
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1414103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical