Provider Demographics
NPI:1306629472
Name:ROSADO ROMAN, NILKA Z (PSYD)
Entity type:Individual
Prefix:DR
First Name:NILKA
Middle Name:Z
Last Name:ROSADO ROMAN
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:HC 2 BOX 21519
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-9228
Mailing Address - Country:US
Mailing Address - Phone:787-231-9405
Mailing Address - Fax:
Practice Address - Street 1:120 CALLE PAVIA FERNANDEZ
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2285
Practice Address - Country:US
Practice Address - Phone:787-231-9405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6137103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6137OtherLICENCIA