Provider Demographics
NPI:1386482909
Name:ROSADO TAVAREZ, RACHEL N
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:N
Last Name:ROSADO TAVAREZ
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 1:102 PARK PLACE BLVD STE D1
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2358
Mailing Address - Country:US
Mailing Address - Phone:407-851-5121
Mailing Address - Fax:
Practice Address - Street 1:102 PARK PLACE BLVD STE D1
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2358
Practice Address - Country:US
Practice Address - Phone:407-851-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health