Provider Demographics
NPI:1649763939
Name:ROSADO, SHANNON (LMHC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:ROSADO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 NE 27TH CT
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7712
Mailing Address - Country:US
Mailing Address - Phone:440-320-9726
Mailing Address - Fax:
Practice Address - Street 1:1355 S NOB HILL RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4231
Practice Address - Country:US
Practice Address - Phone:754-323-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16003101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health