Provider Demographics
NPI:1528944154
Name:ROSARIO-VICENTE, GLORYMAR (PHD)
Entity type:Individual
Prefix:
First Name:GLORYMAR
Middle Name:
Last Name:ROSARIO-VICENTE
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 1:2106 OLATHE BLVD MAILSTOP 4004
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-6300
Mailing Address - Fax:913-588-2253
Practice Address - Street 1:2000 OLATHE BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6300
Practice Address - Fax:913-588-2253
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03455103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical