Provider Demographics
NPI:1235808536
Name:NECIOSUP, KARINA JOCILE (MACP)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:JOCILE
Last Name:NECIOSUP
Suffix:
Gender:F
Credentials:MACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17322 SW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5529
Mailing Address - Country:US
Mailing Address - Phone:786-274-0819
Mailing Address - Fax:
Practice Address - Street 1:2731 EXECUTIVE PARK DR.
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331
Practice Address - Country:US
Practice Address - Phone:754-246-5618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health