Provider Demographics
NPI:1942220322
Name:PASS, ROSLYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSLYN
Middle Name:
Last Name:PASS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9085 SW 87TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2309
Mailing Address - Country:US
Mailing Address - Phone:305-595-2600
Mailing Address - Fax:305-595-2077
Practice Address - Street 1:9085 SW 87TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2309
Practice Address - Country:US
Practice Address - Phone:305-595-2600
Practice Address - Fax:305-595-2077
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2172103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74202Medicare ID - Type Unspecified