Healthcare Provider Details

I. General information

NPI: 1669065009
Provider Name (Legal Business Name): ANGELIVETTE ROSA PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 CALLE 1
BARCELONETA PR
00617
US

IV. Provider business mailing address

HC 2 BOX 8002
BARCELONETA PR
00617-9756
US

V. Phone/Fax

Practice location:
  • Phone: 939-286-0528
  • Fax:
Mailing address:
  • Phone: 939-286-0528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8883
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: