Individual provider Active NPI

Madelene Roserie-Hargrove, LMHC

  • Mental Health Counselor
  • Tampa, FL
National Provider Identifier
1851741292
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH20089 Issued in FL
Practice address
4422 E Columbus Dr
Tampa, FL 33605-3233
Phone
(813) 384-4203
Fax
(813) 984-6729
NPI assigned
Jun 16, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 13928 FL
Mental Health Counselor 101YM0800X MH20089 FL Primary

Addresses

Primary practice location

4422 E Columbus Dr
Tampa, FL 33605-3233

Mailing address

1919 W 10TH St Apt 28
Lakeland, FL 33805-3388
Phone (863) 899-4536

Other identifiers 1

IdentifierTypeStateIssuer
060650200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240904002606 FL Practitioner - Mental Health Counselor 8022558162 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vitae Health Medical Florida PLLCGroup PAC ID 6204166762, 31 clinicians

Practice addresses (Care Compare)

206 W Orange St
Davenport, FL 33837-3118
Phone (863) 422-4961

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13928FLMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Vitae Health Medical Florida PLLC CurrentSince Aug 28, 2024 Accepting new patients

Locations

206 W Orange St
Davenport, FL 33837
Phone (863) 422-4961

2811 Campus Hill Dr
Tampa, FL 33612
Phone (813) 972-9700

303 E Wacker Dr
Ste 1127
Chicago, IL 60601
Phone (312) 328-2347

Networks

  • Freedom Health HMO Network

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1851741292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 W 10TH ST APT 28",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338053388",
            "telephone_number": "863-899-4536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4422 E COLUMBUS DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336053233",
            "telephone_number": "813-384-4203",
            "fax_number": "813-984-6729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSERIE-HARGROVE",
        "first_name": "MADELENE",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-16",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "FL",
            "license": "13928",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH20089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060650200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.