Provider Demographics
NPI:1831970987
Name:ROJAS BRYAN, JESSICA DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DE LA CARIDAD
Last Name:ROJAS BRYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 KELSO AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-6036
Mailing Address - Country:US
Mailing Address - Phone:786-251-8939
Mailing Address - Fax:
Practice Address - Street 1:2500 N MILITARY TRL STE 304
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6324
Practice Address - Country:US
Practice Address - Phone:561-421-5111
Practice Address - Fax:561-421-5222
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-320506106S00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist