Provider Demographics
NPI:1932691029
Name:ROSADO, JONATHAN JOSUE SR (MPSY)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JOSUE
Last Name:ROSADO
Suffix:SR
Gender:M
Credentials:MPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB EL ROSARIO
Mailing Address - Street 2:I7 CALLE B
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-410-3245
Mailing Address - Fax:
Practice Address - Street 1:996 CALLE ST ROBERTO
Practice Address - Street 2:PROFFESIONAL OFFICES EDIFICIO V
Practice Address - City:CUPEY
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-641-0773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5984103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling