Provider Demographics
NPI:1427341833
Name:CASIANO-ROVIRA, JOSE DARIO (MSW)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:DARIO
Last Name:CASIANO-ROVIRA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N LAKEMONT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3205
Mailing Address - Country:US
Mailing Address - Phone:407-963-7639
Mailing Address - Fax:
Practice Address - Street 1:315 N LAKEMONT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3205
Practice Address - Country:US
Practice Address - Phone:407-963-7639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 1041C0700X
PR15885104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker