Provider Demographics
NPI:1588869234
Name:ROSADO, WILFREDO
Entity type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:ROSADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYCHOLOGIST
Mailing Address - Street 1:11 CALLE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 CALLE ALAMEDA
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-3516
Practice Address - Country:US
Practice Address - Phone:787-608-8824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0488103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)