Provider Demographics
NPI:1619583663
Name:ROVERSI - POLLARD, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:ROVERSI - POLLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-4619
Mailing Address - Country:US
Mailing Address - Phone:813-763-5469
Mailing Address - Fax:813-438-8903
Practice Address - Street 1:103 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4619
Practice Address - Country:US
Practice Address - Phone:813-441-8362
Practice Address - Fax:813-438-8903
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-132765106S00000X
FL0-24-15180106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician