Provider Demographics
NPI:1295991578
Name:ROQUE, BERNARDO (PSYD, HCT)
Entity type:Individual
Prefix:DR
First Name:BERNARDO
Middle Name:
Last Name:ROQUE
Suffix:
Gender:M
Credentials:PSYD, HCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. ALTURAS DE SAN BENITO
Mailing Address - Street 2:CALLE REINA DE LA PAZ 11
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-9202
Mailing Address - Country:US
Mailing Address - Phone:787-645-2587
Mailing Address - Fax:
Practice Address - Street 1:CARR. 198 KM 22.0
Practice Address - Street 2:BO. MONTONES I
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00791-0198
Practice Address - Country:US
Practice Address - Phone:787-716-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3156103TC1900X, 103TC0700X
PR8072104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No104100000XBehavioral Health & Social Service ProvidersSocial Worker