Healthcare Provider Details

I. General information

NPI: 1508263682
Provider Name (Legal Business Name): GEMA YUDIT DER ROHE-BORGHESE LICENSED CLINICAL SO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2965 SW 16TH ST
MIAMI FL
33145-1143
US

IV. Provider business mailing address

2965 SW 16TH ST
MIAMI FL
33145-1143
US

V. Phone/Fax

Practice location:
  • Phone: 305-898-5157
  • Fax:
Mailing address:
  • Phone: 305-898-5157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-85895
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW11078
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: