Provider Demographics
NPI:1497379978
Name:RODRIGUEZ FREIRE, ROSANY
Entity Type:Individual
Prefix:
First Name:ROSANY
Middle Name:
Last Name:RODRIGUEZ FREIRE
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 1:1954 COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-2426
Mailing Address - Country:US
Mailing Address - Phone:786-763-5379
Mailing Address - Fax:
Practice Address - Street 1:1954 COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-2426
Practice Address - Country:US
Practice Address - Phone:786-763-5379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20119692106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician