Provider Demographics
NPI:1215655279
Name:CARRERA, KAYLA M
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:M
Last Name:CARRERA
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 1:1731 W 56TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2002
Mailing Address - Country:US
Mailing Address - Phone:786-479-8197
Mailing Address - Fax:
Practice Address - Street 1:7975 NW 154TH ST STE 230
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5849
Practice Address - Country:US
Practice Address - Phone:305-874-7245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT21194301106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician