MEDICARE: MARIA ROVERSI - POLLARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-20-132765	FL
2	106E00000X	Assistant Behavior Analyst	0-24-15180	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619583663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ROVERSI - POLLARD

Provider Business Mailing Address
First Line	:	103 S FLORIDA AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4619
Country	:	US
Telephone Number	:	813-763-5469
Fax Number	:	813-438-8903

Provider Business Practice Location Address
First Line	:	103 S FLORIDA AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4619
Country	:	US
Telephone Number	:	813-441-8362
Fax Number	:	813-438-8903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2020
Last Update Date	:	04/04/2024

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Directions to “ MARIA ROVERSI - POLLARD ” Practice Location

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