Provider Demographics
NPI:1508343401
Name:COSME, GLORIANNE Y
Entity Type:Individual
Prefix:MRS
First Name:GLORIANNE
Middle Name:Y
Last Name:COSME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D28 CALLE 3
Mailing Address - Street 2:LOS ROBLES
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-548-7230
Mailing Address - Fax:
Practice Address - Street 1:1436 AVE PAZ GRANELA
Practice Address - Street 2:SANTIAGO IGLESIAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-0000
Practice Address - Country:US
Practice Address - Phone:787-548-7230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6036103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool