Provider Demographics
NPI:1578038766
Name:ROSENBERG, KASIE BLAKE
Entity Type:Individual
Prefix:
First Name:KASIE
Middle Name:BLAKE
Last Name:ROSENBERG
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 1:130 MANDOLIN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-6001
Mailing Address - Country:US
Mailing Address - Phone:863-464-7419
Mailing Address - Fax:
Practice Address - Street 1:130 MANDOLIN DR
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-6001
Practice Address - Country:US
Practice Address - Phone:863-464-7419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst