Provider Demographics
NPI:1073670808
Name:KARBONIK, ELAINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:KARBONIK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 E OAKLAND PARK BLVD #202
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306
Mailing Address - Country:US
Mailing Address - Phone:954-290-7587
Mailing Address - Fax:954-285-0025
Practice Address - Street 1:2717 E OAKLAND PARK BLVD #202
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306
Practice Address - Country:US
Practice Address - Phone:954-290-7587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6992103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U3432YMedicare UPIN