Provider Demographics
NPI:1366967242
Name:ZIPF, ROSE SANDRA (BA)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:SANDRA
Last Name:ZIPF
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LIGHTHOUSE COMMUNITY SERVICES, 1668-OLD CYPRESS TRAIL
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6109
Mailing Address - Country:US
Mailing Address - Phone:561-502-7025
Mailing Address - Fax:
Practice Address - Street 1:1668 OLD CYPRESS TRL
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6002
Practice Address - Country:US
Practice Address - Phone:561-502-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst