Provider Demographics
NPI:1033742572
Name:CARRASCO, GISSEL KARINA
Entity Type:Individual
Prefix:
First Name:GISSEL
Middle Name:KARINA
Last Name:CARRASCO
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 1:3395 NE 10TH ST UNIT 203
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5314
Mailing Address - Country:US
Mailing Address - Phone:305-910-5105
Mailing Address - Fax:
Practice Address - Street 1:3395 NE 10TH ST UNIT 203
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5314
Practice Address - Country:US
Practice Address - Phone:305-910-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT20-109710106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician