Provider Demographics
NPI:1245756048
Name:ROSARIO, JENNIFER (RMHCI)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2197 GRANGER AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2205
Mailing Address - Country:US
Mailing Address - Phone:386-215-7830
Mailing Address - Fax:
Practice Address - Street 1:3483 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4668
Practice Address - Country:US
Practice Address - Phone:386-215-7830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10274101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health