Provider Demographics
NPI:1033724695
Name:CARO, MAY GRISSELL
Entity Type:Individual
Prefix:
First Name:MAY
Middle Name:GRISSELL
Last Name:CARO
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 1:228 SW 83RD WAY UNIT 204
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5414
Mailing Address - Country:US
Mailing Address - Phone:786-643-7819
Mailing Address - Fax:
Practice Address - Street 1:228 SW 83RD WAY UNIT 204
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-5414
Practice Address - Country:US
Practice Address - Phone:786-643-7819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-129376106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician