Provider Demographics
NPI:1396628913
Name:ROSADO, VIVIANA L (PHD)
Entity type:Individual
Prefix:
First Name:VIVIANA
Middle Name:L
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 1:2023 COND LA CORUNA CARR. 177
Mailing Address - Street 2:APT 1002
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5184
Mailing Address - Country:US
Mailing Address - Phone:787-512-0129
Mailing Address - Fax:
Practice Address - Street 1:3950 CARR 176 GARDEN VALLEY CLUB
Practice Address - Street 2:APT 108
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6137
Practice Address - Country:US
Practice Address - Phone:787-512-0129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8280103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical