Provider Demographics
NPI:1740993492
Name:REYES ROSADO, MICHELLE JOELIZ (MS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JOELIZ
Last Name:REYES ROSADO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SECTOR ROSADO, BO. CUCHILLAS
Mailing Address - Street 2:CARR 619 KM 3.0
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687
Mailing Address - Country:US
Mailing Address - Phone:939-276-9226
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 155 KM 55.9
Practice Address - Street 2:BO FRANQUEZ
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-0068
Practice Address - Country:US
Practice Address - Phone:939-276-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7421103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist