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General NPI Number Information
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NPI Number | 1992247373
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Entity Type | Individual
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Provider Name | LIZVEL ROSARIO M.A.
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Gender | Female
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 220 LAKE WIRE DR.
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City | LAKELAND
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State | FL
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Zip | 33815
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Country | US
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Telephone | 863-845-0542
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Fax |
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Provider Business Mailing Address
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Address Line | 430 E PACKWOOD AVE APT. E106
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City | MAITLAND
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State | FL
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Zip | 32751-5700
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Country | US
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Telephone | 407-929-4106
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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