Provider Demographics
NPI:1962948851
Name:BARRERA, EVELYN MARIA (EDS)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:MARIA
Last Name:BARRERA
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 TRUMAN DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3111
Mailing Address - Country:US
Mailing Address - Phone:305-785-3422
Mailing Address - Fax:
Practice Address - Street 1:1275 W 47TH PL STE 407
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3451
Practice Address - Country:US
Practice Address - Phone:786-859-9369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS575103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool