Provider Demographics
NPI:1467445528
Name:LOPEZ-ROSADO, YMA (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:YMA
Middle Name:
Last Name:LOPEZ-ROSADO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 CALLE FERROCARRIL
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1106
Mailing Address - Country:US
Mailing Address - Phone:787-466-2217
Mailing Address - Fax:787-437-0245
Practice Address - Street 1:516 CALLE FERROCARRIL
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1106
Practice Address - Country:US
Practice Address - Phone:787-466-2217
Practice Address - Fax:787-437-0245
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2017-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2263103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0056800Medicare ID - Type Unspecified
Q45451Medicare UPIN