Healthcare Provider Details

I. General information

NPI: 1619583663
Provider Name (Legal Business Name): MARIA ROVERSI - POLLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S FLORIDA AVE
LAKELAND FL
33801-4619
US

IV. Provider business mailing address

103 S FLORIDA AVE
LAKELAND FL
33801-4619
US

V. Phone/Fax

Practice location:
  • Phone: 813-441-8362
  • Fax: 813-438-8903
Mailing address:
  • Phone: 813-763-5469
  • Fax: 813-438-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15180
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-132765
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: