Provider Demographics
NPI:1578716627
Name:ROSADO, GLORYMEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLORYMEL
Middle Name:
Last Name:ROSADO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 URB LAKEVIEW EST
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3383
Mailing Address - Country:US
Mailing Address - Phone:787-518-3911
Mailing Address - Fax:
Practice Address - Street 1:MAGINAL VILLAMAR #1207
Practice Address - Street 2:ISLA VERDE
Practice Address - City:CAROLINA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00979
Practice Address - Country:UM
Practice Address - Phone:787-539-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR95571041C0700X
PR7862103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical