Provider Demographics
NPI:1396551156
Name:ROSARIO, LIJAH LYNDON
Entity type:Individual
Prefix:
First Name:LIJAH
Middle Name:LYNDON
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:LYNN
Other - Last Name:ROSARIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:806 MYSTIC DR APT 403D
Mailing Address - Street 2:
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-5334
Mailing Address - Country:US
Mailing Address - Phone:321-376-3744
Mailing Address - Fax:
Practice Address - Street 1:806 MYSTIC DR APT 403D
Practice Address - Street 2:
Practice Address - City:CAPE CANAVERAL
Practice Address - State:FL
Practice Address - Zip Code:32920-5334
Practice Address - Country:US
Practice Address - Phone:321-376-3744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician