Provider Demographics
NPI:1457441727
Name:ROSARIO, TAMARA A (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:A
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11077 BISCAYNE BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7568
Mailing Address - Country:US
Mailing Address - Phone:305-400-4845
Mailing Address - Fax:305-400-4845
Practice Address - Street 1:11077 BISCAYNE BLVD STE 410
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-7568
Practice Address - Country:US
Practice Address - Phone:305-400-4845
Practice Address - Fax:305-400-4845
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9198101YM0800X, 103K00000X, 101YP2500X
104100000X
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019772000Medicaid