Provider Demographics
NPI:1588012827
Name:BURGOS BERNIER, ROSA IVELISSE (MSW)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:IVELISSE
Last Name:BURGOS BERNIER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VIVES CALLE E # 180
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00784
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:URB. VIVES CALLE E
Practice Address - Street 2:#180
Practice Address - City:GUAYAMA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00784
Practice Address - Country:UM
Practice Address - Phone:787-929-7910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR127511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical