Provider Demographics
NPI:1114483385
Name:ROSADO VARGAS, JOAN IVELISSE (MRC)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:IVELISSE
Last Name:ROSADO VARGAS
Suffix:
Gender:F
Credentials:MRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 6 BOX 4286
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00780-9515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BO GARZAS
Practice Address - Street 2:CARR 10 KM 0.4
Practice Address - City:ADJUNTAS
Practice Address - State:PR
Practice Address - Zip Code:00601
Practice Address - Country:US
Practice Address - Phone:787-967-8483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRCAT-IV-41575101YA0400X
PR1632225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)