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General NPI Number Information
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NPI Number | 1558877332
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Entity Type | Individual
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Provider Name | ROSE MEDGINE DUBOIS
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Gender | Female
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Dates
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Enumeration Date | 12/16/2017
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 8016 80TH WAY
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-6781
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Country | US
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Telephone | 561-567-3114
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Fax |
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Provider Business Mailing Address
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Address Line | 8016 80TH WAY
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-6781
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Country | US
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Telephone | 561-567-3114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-22-59533
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License Number State | FL
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