Provider Demographics
NPI:1366085573
Name:ROSSI CLERICI, VALERIA MARINA
Entity type:Individual
Prefix:
First Name:VALERIA
Middle Name:MARINA
Last Name:ROSSI CLERICI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VALERIA
Other - Middle Name:MARINA
Other - Last Name:CLERICI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:231 S FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-4060
Mailing Address - Country:US
Mailing Address - Phone:352-364-2666
Mailing Address - Fax:352-527-1032
Practice Address - Street 1:8001 BEATY GROVE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1602
Practice Address - Country:US
Practice Address - Phone:813-926-5454
Practice Address - Fax:813-920-9252
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician