Provider Demographics
NPI:1285775809
Name:FAJARDO, CARMEN G (BS)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:G
Last Name:FAJARDO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1601 NW 12TH AVE
Mailing Address - Street 2:UNIVERSITY OF MIAMI EARLY STEPS PROGRAM
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-243-6660
Mailing Address - Fax:305-243-3501
Practice Address - Street 1:1601 NW 12TH AVE
Practice Address - Street 2:UNIVERSITY OF MIAMI EARLY STEPS PROGRAM
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-243-6660
Practice Address - Fax:305-243-3501
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL754590800Medicaid