Provider Demographics
NPI:1003343401
Name:DEL REY, CAROLINE CATHERINE (MT-BC)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:CATHERINE
Last Name:DEL REY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CROOKED OAK CT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3402
Mailing Address - Country:US
Mailing Address - Phone:1407-462-6855
Mailing Address - Fax:
Practice Address - Street 1:14 PORTER ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2116
Practice Address - Country:US
Practice Address - Phone:617-569-3189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12488225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist