Provider Demographics
NPI:1689427924
Name:NOVO PEREZ, ROSANA
Entity Type:Individual
Prefix:
First Name:ROSANA
Middle Name:
Last Name:NOVO PEREZ
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 1:1114 COCHRAN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-5715
Mailing Address - Country:US
Mailing Address - Phone:561-537-1804
Mailing Address - Fax:
Practice Address - Street 1:1114 COCHRAN DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH BEACH
Practice Address - State:FL
Practice Address - Zip Code:33461-5715
Practice Address - Country:US
Practice Address - Phone:561-537-1804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-336200106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty