Provider Demographics
NPI:1619626108
Name:JOSE, ROCELIA (RBT)
Entity Type:Individual
Prefix:
First Name:ROCELIA
Middle Name:
Last Name:JOSE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5103 SE PRIMROSE WAY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-8008
Mailing Address - Country:US
Mailing Address - Phone:772-800-9158
Mailing Address - Fax:
Practice Address - Street 1:5103 SE PRIMROSE WAY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-8008
Practice Address - Country:US
Practice Address - Phone:772-800-9158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician