Provider Demographics
NPI:1427897602
Name:GOSS, REBECCA ROSE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ROSE
Last Name:GOSS
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 1:29500 US 27
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DUNDEE
Mailing Address - State:FL
Mailing Address - Zip Code:33838
Mailing Address - Country:US
Mailing Address - Phone:863-349-5323
Mailing Address - Fax:
Practice Address - Street 1:29500 US 27
Practice Address - Street 2:SUITE 1
Practice Address - City:DUNDEE
Practice Address - State:FL
Practice Address - Zip Code:33838
Practice Address - Country:US
Practice Address - Phone:863-349-5323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst