Provider Demographics
NPI:1093206906
Name:ROSAS, ANASOFIA ROCHA
Entity Type:Individual
Prefix:
First Name:ANASOFIA
Middle Name:ROCHA
Last Name:ROSAS
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 1:851 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5257
Mailing Address - Country:US
Mailing Address - Phone:931-542-2168
Mailing Address - Fax:
Practice Address - Street 1:851 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5257
Practice Address - Country:US
Practice Address - Phone:931-542-2168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-18-56616106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician