Provider Demographics
NPI:1194184549
Name:ROS, NICOLE (MA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ROS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11-24 CALLE SEGOVIA
Mailing Address - Street 2:URB. TORRIMAR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-3101
Mailing Address - Country:US
Mailing Address - Phone:787-222-6551
Mailing Address - Fax:
Practice Address - Street 1:634 CALLE ALDEBARAN
Practice Address - Street 2:URB. ALTAMIRA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-4226
Practice Address - Country:US
Practice Address - Phone:787-222-6551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-14
Last Update Date:2016-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5626103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist