Provider Demographics
NPI:1699264150
Name:CARRERA, NATHALIE
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:
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 1:5916 LAKE FRONT DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-4234
Mailing Address - Country:US
Mailing Address - Phone:786-367-2532
Mailing Address - Fax:
Practice Address - Street 1:517 DELTONA BLVD STE A
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8016
Practice Address - Country:US
Practice Address - Phone:386-259-5413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health