Provider Demographics
NPI:1215204433
Name:DIEZ DE SOLLANO, CARINA (LCSW)
Entity Type:Individual
Prefix:
First Name:CARINA
Middle Name:
Last Name:DIEZ DE SOLLANO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13101 SW 15TH CT APT 411
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2415
Mailing Address - Country:US
Mailing Address - Phone:305-338-6219
Mailing Address - Fax:
Practice Address - Street 1:13101 SW 15TH CT APT 411
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-2415
Practice Address - Country:US
Practice Address - Phone:305-338-6219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLSW102251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020648000Medicaid
GA004255600Medicaid