Healthcare Provider Details

I. General information

NPI: 1184961682
Provider Name (Legal Business Name): KARIANNE SZPAK ROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11840 BROOKSIDE DR
BRADENTON FL
34211-4527
US

IV. Provider business mailing address

11840 BROOKSIDE DR
LAKEWOOD RANCH FL
34211-4527
US

V. Phone/Fax

Practice location:
  • Phone: 724-777-1518
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: