Provider Demographics
NPI:1730484445
Name:ROSA, LIZBETH (MA)
Entity Type:Individual
Prefix:
First Name:LIZBETH
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50590
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-0590
Mailing Address - Country:US
Mailing Address - Phone:787-435-7033
Mailing Address - Fax:
Practice Address - Street 1:RES BARRIO PALMAS
Practice Address - Street 2:288 COLTON
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-5900
Practice Address - Country:US
Practice Address - Phone:787-726-4643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2810103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool