Provider Demographics
NPI:1265814966
Name:KASKEL, SAMIRA
Entity Type:Individual
Prefix:
First Name:SAMIRA
Middle Name:
Last Name:KASKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMIRA
Other - Middle Name:
Other - Last Name:KASKEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SSP
Mailing Address - Street 1:9231 SW 136TH STREET CIR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-5823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8525 SW 92ND ST
Practice Address - Street 2:SUITE A-3
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7365
Practice Address - Country:US
Practice Address - Phone:305-803-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS 1147103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool