Provider Demographics
NPI:1205229390
Name:ELJAUA, ROSEMARY (EDS)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:ELJAUA
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 NW 161ST AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1168
Mailing Address - Country:US
Mailing Address - Phone:954-830-1172
Mailing Address - Fax:
Practice Address - Street 1:990 NW 161ST AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1168
Practice Address - Country:US
Practice Address - Phone:954-830-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS730103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool