Provider Demographics
NPI:1629420591
Name:ROSELLO-PATRICK, BREESA
Entity Type:Individual
Prefix:
First Name:BREESA
Middle Name:
Last Name:ROSELLO-PATRICK
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 1:1406 HAYS ST STE 8
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2843
Mailing Address - Country:US
Mailing Address - Phone:904-619-8430
Mailing Address - Fax:
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 1501
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6298
Practice Address - Country:US
Practice Address - Phone:904-619-8430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst