Provider Demographics
NPI:1336370501
Name:HUBER, ROSE CHANTAL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:CHANTAL
Last Name:HUBER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 SW 62ND PL STE 210
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4825
Mailing Address - Country:US
Mailing Address - Phone:305-901-7350
Mailing Address - Fax:786-732-4087
Practice Address - Street 1:7330 SW 62ND PL STE 210
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4825
Practice Address - Country:US
Practice Address - Phone:305-901-7350
Practice Address - Fax:786-732-4087
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7973103T00000X
FLIN PROGESS103TC0700X
FL103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical