Healthcare Provider Details

I. General information

NPI: 1154857498
Provider Name (Legal Business Name): ROSA BARROSO, LMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 11/12/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17670 NW 78TH AVENUE SUITE 205
HIALEAH FL
33015
US

IV. Provider business mailing address

8004 NW 154TH ST # 418
MIAMI LAKES FL
33016-5814
US

V. Phone/Fax

Practice location:
  • Phone: 305-530-8119
  • Fax:
Mailing address:
  • Phone: 305-530-8119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12983
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ROSA BARROSO
Title or Position: OWNER
Credential: LMHC
Phone: 305-530-8119