Healthcare Provider Details

I. General information

NPI: 1831849199
Provider Name (Legal Business Name): ROXANA MARRERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 MARK LN
LAKELAND FL
33810-3843
US

IV. Provider business mailing address

1516 MARK LN
LAKELAND FL
33810-3843
US

V. Phone/Fax

Practice location:
  • Phone: 305-972-2437
  • Fax:
Mailing address:
  • Phone: 305-972-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90217
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: