Provider Demographics
NPI:1558760488
Name:BRYSON, ROSETTA
Entity Type:Individual
Prefix:MS
First Name:ROSETTA
Middle Name:
Last Name:BRYSON
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 1:700 SW 78TH AVE
Mailing Address - Street 2:SUITE 909
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3298
Mailing Address - Country:US
Mailing Address - Phone:800-604-3656
Mailing Address - Fax:866-776-7556
Practice Address - Street 1:700 SW 78TH AVE
Practice Address - Street 2:SUITE 909
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3298
Practice Address - Country:US
Practice Address - Phone:800-604-3656
Practice Address - Fax:866-776-7556
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor