Provider Demographics
NPI:1437540408
Name:KNOWLEDGE TO MANAGE CHANGE LLC
Entity Type:Organization
Organization Name:KNOWLEDGE TO MANAGE CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSSO
Authorized Official - Middle Name:
Authorized Official - Last Name:VIVIANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-314-8398
Mailing Address - Street 1:726 CALLE LUIS ALMANSA
Mailing Address - Street 2:URB FAIR VIEW
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7719
Mailing Address - Country:US
Mailing Address - Phone:787-314-8398
Mailing Address - Fax:787-545-1559
Practice Address - Street 1:CARR 843 KM 7.4 LOTE 19
Practice Address - Street 2:URB VISTA DE LAGO CAMPO
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-314-8398
Practice Address - Fax:787-545-1559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty