Provider Demographics
NPI:1497509566
Name:ROSA, YVONNE (LICENSE PSHYC)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:LICENSE PSHYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RES PADRE RIVERA
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-4171
Mailing Address - Country:US
Mailing Address - Phone:939-645-2264
Mailing Address - Fax:
Practice Address - Street 1:PADRE RIVERA 15- OESTE
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4171
Practice Address - Country:US
Practice Address - Phone:939-645-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7899103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty