Basic Information
| Provider Information | |||||||||
| NPI: | 1558760488 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRYSON | ||||||||
| FirstName: | ROSETTA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 SW 78TH AVE | ||||||||
| Address2: | SUITE 909 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333243298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006043656 | ||||||||
| FaxNumber: | 8667767556 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 SW 78TH AVE | ||||||||
| Address2: | SUITE 909 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333243298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006043656 | ||||||||
| FaxNumber: | 8667767556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2014 | ||||||||
| LastUpdateDate: | 08/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | FL | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.