Provider Demographics
NPI:1124888318
Name:CARASA FERNANDEZ, IVETTE
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:CARASA FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17411 SW 153RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-1318
Mailing Address - Country:US
Mailing Address - Phone:786-608-4677
Mailing Address - Fax:
Practice Address - Street 1:17411 SW 153RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-1318
Practice Address - Country:US
Practice Address - Phone:786-608-4677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician