| Entity Name: | ALIZA ROSEN PSY.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 Feb 2000 (25 years ago) |
| Document Number: | P00000013845 |
| FEI/EIN Number | 650979906 |
| Address: | 6767 N. Wickham Road, STE 306, Melbourne, FL, 32940, US |
| Mail Address: | 4607 MERLOT DR, VIERA, FL, 32955 |
| ZIP code: | 32940 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134213903 | 2006-10-03 | 2020-02-20 | 1370 BEDFORD DR STE 102, MELBOURNE, FL, 329401993, US | 1370 BEDFORD DR, 106, MELBOURNE, FL, 329401993, US | |||||||||||||||||||
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| Phone | +1 321-757-7957 |
| Fax | 3212654015 |
Authorized person
| Name | DR. ALIZA N ROSEN |
| Role | PRESIDENT |
| Phone | 3217577957 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY6029 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ROSEN ALIZA | Agent | 4607 MERLOT DR, VIERA, FL, 32955 |
| Name | Role | Address |
|---|---|---|
| ROSEN ALIZA | Director | 4607 MERLOT DR, VIERA, FL, 32955 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-11 | 6767 N. Wickham Road, STE 306, Melbourne, FL 32940 | No data |
| CHANGE OF MAILING ADDRESS | 2012-03-07 | 6767 N. Wickham Road, STE 306, Melbourne, FL 32940 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-04-14 | 4607 MERLOT DR, VIERA, FL 32955 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-11 |
| ANNUAL REPORT | 2023-03-10 |
| ANNUAL REPORT | 2022-01-29 |
| ANNUAL REPORT | 2021-03-18 |
| ANNUAL REPORT | 2020-03-06 |
| ANNUAL REPORT | 2019-03-04 |
| ANNUAL REPORT | 2018-04-15 |
| ANNUAL REPORT | 2017-03-24 |
| ANNUAL REPORT | 2016-04-12 |
| ANNUAL REPORT | 2015-04-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
