Provider Demographics
NPI:1619688728
Name:ROSA, JOSELINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOSELINE
Middle Name:
Last Name:ROSA
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:A CONDOMINIO JARDINES DE SAN IGNACIO
Mailing Address - Street 2:APARTAMENTO 413-A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:939-417-5697
Mailing Address - Fax:
Practice Address - Street 1:CARR 22, BARRIO MONACILLO 3ER PISO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-763-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7449103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6025792OtherNON-MEDICARE
PR7449OtherNON-MEDICARE