Provider Demographics
NPI:1568752194
Name:ROSATO, JOSEPH SHANE (BCBA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:SHANE
Last Name:ROSATO
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 SATURN ST SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-9230
Mailing Address - Country:US
Mailing Address - Phone:321-848-4156
Mailing Address - Fax:
Practice Address - Street 1:1162 SATURN ST SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-9230
Practice Address - Country:US
Practice Address - Phone:321-848-4156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-16
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-07-3913103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001432400Medicaid