Provider Demographics
NPI:1457873085
Name:DIAZ ROSADO, LILLIAN VANESSA (SW)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:VANESSA
Last Name:DIAZ 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:HC 23 BOX 6104
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-9710
Mailing Address - Country:US
Mailing Address - Phone:787-222-5956
Mailing Address - Fax:
Practice Address - Street 1:17- 1 AVE MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-222-5956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR67171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical