Provider Demographics
NPI:1598424756
Name:HALE, ROSEMARY (REGISTER BEHAVIOR T)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:HALE
Suffix:
Gender:
Credentials:REGISTER BEHAVIOR T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SHELTER COVE CIR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-2786
Mailing Address - Country:US
Mailing Address - Phone:386-338-2909
Mailing Address - Fax:
Practice Address - Street 1:8 WILDWOOD LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3221
Practice Address - Country:US
Practice Address - Phone:386-338-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB737407106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017604200Medicaid
FL112929900Medicaid