Provider Demographics
NPI:1700420270
Name:ROSADO, MARLYN
Entity Type:Individual
Prefix:MRS
First Name:MARLYN
Middle Name:
Last Name:ROSADO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARLYN
Other - Middle Name:
Other - Last Name:ROSADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CALLE NUNEZ ROMEU #55
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736
Mailing Address - Country:US
Mailing Address - Phone:939-400-1441
Mailing Address - Fax:787-738-1800
Practice Address - Street 1:CALLE NUNEZ ROMEU #55
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-1800
Practice Address - Fax:787-738-1800
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR374700000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No374700000XNursing Service Related ProvidersTechnician