Provider Demographics
NPI:1891080131
Name:ROSADO, DEBRA L (CMHP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:ROSADO
Suffix:
Gender:F
Credentials:CMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N MAIN ST. SUITE 1
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744
Mailing Address - Country:US
Mailing Address - Phone:321-206-6560
Mailing Address - Fax:321-250-5253
Practice Address - Street 1:911 N MAIN ST. SUITE 1
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744
Practice Address - Country:US
Practice Address - Phone:321-206-6560
Practice Address - Fax:321-250-5253
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBTR-03286101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health