Provider Demographics
NPI:1790587467
Name:POULIN, ROSITA JENNIFER
Entity type:Individual
Prefix:
First Name:ROSITA
Middle Name:JENNIFER
Last Name:POULIN
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 1:8318 BRAESPOINT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-2881
Mailing Address - Country:US
Mailing Address - Phone:210-478-8059
Mailing Address - Fax:
Practice Address - Street 1:208 COUNTY ROAD 260 W
Practice Address - Street 2:
Practice Address - City:MICO
Practice Address - State:TX
Practice Address - Zip Code:78056-2218
Practice Address - Country:US
Practice Address - Phone:210-882-6062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician