Provider Demographics
NPI:1033619531
Name:HERRERA, KAROLAY CHARBET (BEHAVIOR ANALYSIS)
Entity Type:Individual
Prefix:
First Name:KAROLAY
Middle Name:CHARBET
Last Name:HERRERA
Suffix:
Gender:F
Credentials:BEHAVIOR ANALYSIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12355 SW 18TH ST APT 311
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-1528
Mailing Address - Country:US
Mailing Address - Phone:786-355-9564
Mailing Address - Fax:
Practice Address - Street 1:12355 SW 18TH ST APT 311
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-1528
Practice Address - Country:US
Practice Address - Phone:786-355-9564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR$$$$$$$$$Medicaid