Provider Demographics
NPI:1922508308
Name:ROSADO, LILLIAN (LMSW)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:ROSADO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:LILLIAN
Other - Middle Name:
Other - Last Name:ROSADO ROCHE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDA LILLIAN ROSADO
Mailing Address - Street 1:1577 CALLE NAIRA
Mailing Address - Street 2:COMUNIDAD PUNTA DIAMANTE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:787-319-9066
Mailing Address - Fax:
Practice Address - Street 1:1577 CALLE NAIRA
Practice Address - Street 2:COMUNIDAD PUNTA DIAMANTE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-319-9066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 102L00000X, 103TF0200X, 171M00000X, 174H00000X, 261QM0855X
PR96871041S0200X, 171000000X, 405300000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty
No171000000XOther Service ProvidersMilitary Health Care Provider
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No405300000XOther Service ProvidersPrevention Professional