Provider Demographics
NPI:1902508039
Name:FELISTIN, ROSELINE (MSW)
Entity Type:Individual
Prefix:
First Name:ROSELINE
Middle Name:
Last Name:FELISTIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 BETHUNE DR
Mailing Address - Street 2:
Mailing Address - City:LOCKHART
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6417
Mailing Address - Country:US
Mailing Address - Phone:479-235-0129
Mailing Address - Fax:
Practice Address - Street 1:225 S SWOOPE AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5704
Practice Address - Country:US
Practice Address - Phone:407-622-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty