Provider Demographics
NPI:1427392240
Name:DELROSARIO, LYNDON PETER (BCABA)
Entity Type:Individual
Prefix:
First Name:LYNDON
Middle Name:PETER
Last Name:DELROSARIO
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4880 EMPIRE AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-2172
Mailing Address - Country:US
Mailing Address - Phone:904-859-4845
Mailing Address - Fax:
Practice Address - Street 1:2225 BEMISS RD
Practice Address - Street 2:SUITE D
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-4818
Practice Address - Country:US
Practice Address - Phone:904-859-4845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst