Provider Demographics
NPI:1699189399
Name:ROSA, KATHIA JAZMIN (MA PSY)
Entity Type:Individual
Prefix:
First Name:KATHIA
Middle Name:JAZMIN
Last Name:ROSA
Suffix:
Gender:F
Credentials:MA PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#46 CALLE 15
Mailing Address - Street 2:PARCELAS HILL BROTHER
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-528-6446
Mailing Address - Fax:
Practice Address - Street 1:3 CALLE MUNOZ RIVERA ACUARELA
Practice Address - Street 2:KOI BLDG. G-10
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-528-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5580103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling