Provider Demographics
NPI:1275348922
Name:STA ROSA, JAYVEE JANE
Entity type:Individual
Prefix:
First Name:JAYVEE
Middle Name:JANE
Last Name:STA ROSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6196 WILLOUGHBY CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-9300
Mailing Address - Country:US
Mailing Address - Phone:561-231-4453
Mailing Address - Fax:
Practice Address - Street 1:420 S STATE ROAD 7 STE 118
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4304
Practice Address - Country:US
Practice Address - Phone:561-568-9367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician