Provider Demographics
NPI:1871107870
Name:ROSALES, DANAE I
Entity type:Individual
Prefix:MRS
First Name:DANAE
Middle Name:
Last Name:ROSALES
Suffix:I
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DANAE
Other - Middle Name:
Other - Last Name:ROSALES
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:30242 SW 155TH PL
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-3502
Mailing Address - Country:US
Mailing Address - Phone:786-283-2565
Mailing Address - Fax:
Practice Address - Street 1:30242 SW 155TH PL
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-3502
Practice Address - Country:US
Practice Address - Phone:786-283-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR242160707250Medicaid