Provider Demographics
NPI:1649906926
Name:ROLDAN, ROSARIO YANET (RBT)
Entity type:Individual
Prefix:
First Name:ROSARIO
Middle Name:YANET
Last Name:ROLDAN
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 1:12600 SW 29TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2145
Mailing Address - Country:US
Mailing Address - Phone:305-988-4026
Mailing Address - Fax:
Practice Address - Street 1:2636 SW 144TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-7462
Practice Address - Country:US
Practice Address - Phone:305-221-0059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-219375106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician