Provider Demographics
NPI:1972261782
Name:OYOLA ROSADO, MAYDA (SW)
Entity Type:Individual
Prefix:
First Name:MAYDA
Middle Name:
Last Name:OYOLA ROSADO
Suffix:
Gender:F
Credentials:SW
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 169
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-0169
Mailing Address - Country:US
Mailing Address - Phone:787-408-3520
Mailing Address - Fax:
Practice Address - Street 1:9 CALLE BARBOSA
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5702
Practice Address - Country:US
Practice Address - Phone:787-408-3520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22730104100000X
PR284101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker