Provider Demographics
NPI:1992247373
Name:ROSARIO, LIZVEL (MA)
Entity type:Individual
Prefix:
First Name:LIZVEL
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 E PACKWOOD AVE
Mailing Address - Street 2:APT. E106
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5700
Mailing Address - Country:US
Mailing Address - Phone:407-929-4106
Mailing Address - Fax:
Practice Address - Street 1:220 LAKE WIRE DR.
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815
Practice Address - Country:US
Practice Address - Phone:863-845-0542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health