Provider Demographics
NPI:1811288640
Name:ALONSO, ROSA (MA, BCBA)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:ALONSO
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:902 W LUMSDEN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8806
Mailing Address - Country:US
Mailing Address - Phone:813-324-7538
Mailing Address - Fax:813-324-7538
Practice Address - Street 1:902 W LUMSDEN RD STE 105
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8806
Practice Address - Country:US
Practice Address - Phone:813-324-7538
Practice Address - Fax:813-324-7538
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLBA0000000569103K00000X
FLBCABA0-14-6206103K00000X
FL1-19-37761103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty