Provider Demographics
NPI:1447083456
Name:RIVERA ROSADO, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:RIVERA ROSADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-0365
Mailing Address - Country:US
Mailing Address - Phone:787-473-1020
Mailing Address - Fax:
Practice Address - Street 1:BARRIO NUEVO
Practice Address - Street 2:CARRETERA 164 KM 4 HM 0
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-0365
Practice Address - Country:US
Practice Address - Phone:787-473-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7430103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling