Provider Demographics
NPI:1770984916
Name:ROSARIO, LOURDES I
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:I
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:H12 CALLE 8
Mailing Address - Street 2:URB. VILLA EL ENCANTO
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00795
Mailing Address - Country:UM
Mailing Address - Phone:787-209-4256
Mailing Address - Fax:
Practice Address - Street 1:H12 CALLE 8
Practice Address - Street 2:URB. VILLA EL ENCANTO
Practice Address - City:JUANA DIAZ
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00795
Practice Address - Country:UM
Practice Address - Phone:787-209-4256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)