Provider Demographics
NPI:1558648196
Name:CARRERA, KATRINA NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:NICOLE
Last Name:CARRERA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6671 W INDIANTOWN RD STE 50-153
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3991
Mailing Address - Country:US
Mailing Address - Phone:561-205-6887
Mailing Address - Fax:
Practice Address - Street 1:6671 W INDIANTOWN RD STE 50-153
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3991
Practice Address - Country:US
Practice Address - Phone:561-205-6887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10778103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical