Provider Demographics
NPI:1790225613
Name:CEBALLOS-ROSARIO, ADEL MARIE (LMHC)
Entity Type:Individual
Prefix:
First Name:ADEL
Middle Name:MARIE
Last Name:CEBALLOS-ROSARIO
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 1:330 W 62ND ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2648
Mailing Address - Country:US
Mailing Address - Phone:786-253-8593
Mailing Address - Fax:
Practice Address - Street 1:1575 DETRICK AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-2042
Practice Address - Country:US
Practice Address - Phone:407-906-8633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14780101YM0800X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health