Provider Demographics
NPI:1760810394
Name:DAVIS-ROSARIO, SAFIYAH R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SAFIYAH
Middle Name:R
Last Name:DAVIS-ROSARIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SAFIYAH
Other - Middle Name:R
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3246 N. MIAMI AVENUE
Mailing Address - Street 2:SUITE A #370585
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2871
Mailing Address - Country:US
Mailing Address - Phone:862-237-8088
Mailing Address - Fax:
Practice Address - Street 1:3246 N. MIAMI AVENUE
Practice Address - Street 2:SUITE A #370585
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2871
Practice Address - Country:US
Practice Address - Phone:862-237-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW11957104100000X, 1041C0700X
NJ44SL05647500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021236500Medicaid