Provider Demographics
NPI:1053956367
Name:DOMOND, ROSETTE (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:ROSETTE
Middle Name:
Last Name:DOMOND
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1398 SUMMIT PINES BLVD APT 836
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-5102
Mailing Address - Country:US
Mailing Address - Phone:561-503-0609
Mailing Address - Fax:
Practice Address - Street 1:3595 2ND AVE N
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-4027
Practice Address - Country:US
Practice Address - Phone:561-357-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician