Provider Demographics
NPI:1538718101
Name:JURJO ROLLON, ELAINE (RBT)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:JURJO ROLLON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13063 SW 256TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6923
Mailing Address - Country:US
Mailing Address - Phone:305-399-3717
Mailing Address - Fax:
Practice Address - Street 1:13063 SW 256TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6923
Practice Address - Country:US
Practice Address - Phone:305-399-3717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT1997485103K00000X
FLRBT-19-97485106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104105500Medicaid