Provider Demographics
NPI:1134002371
Name:CARDOSO, ROGER ADRIAN SR
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:ADRIAN
Last Name:CARDOSO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20330 NE 2ND AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33179-2338
Mailing Address - Country:US
Mailing Address - Phone:305-813-7520
Mailing Address - Fax:
Practice Address - Street 1:20330 NE 2ND AVE APT 8
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33179-2338
Practice Address - Country:US
Practice Address - Phone:305-813-7520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-452183106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician