Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CAT-IV-41575 | PR |
Y | 225C00000X | Rehabilitation Counselor | 1632 | PR |
NPI | 1114483385 |
---|---|
Provider Name | Mrs. Joan Ivelisse Rosado Vargas |
First Address | Ponce, PR 00780-9515 |
Second Address | Adjuntas, PR 00601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2019 |
Last Update Date | 16/07/2019 |