Healthcare Provider Details

I. General information

NPI: 1801398615
Provider Name (Legal Business Name): STEPHANIE ROSADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13200 SW 128TH ST STE A2
MIAMI FL
33186-5826
US

IV. Provider business mailing address

13200 SW 128TH ST STE A2
MIAMI FL
33186-5826
US

V. Phone/Fax

Practice location:
  • Phone: 786-738-6468
  • Fax:
Mailing address:
  • Phone: 786-738-6468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberIMH22264
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY13051
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: