Provider Demographics
NPI:1326548405
Name:CARR, SORAYA CARMEN (LMHC)
Entity Type:Individual
Prefix:
First Name:SORAYA
Middle Name:CARMEN
Last Name:CARR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SORAYA
Other - Middle Name:CARMEN
Other - Last Name:DORISMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22512 LOGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-3948
Mailing Address - Country:US
Mailing Address - Phone:561-674-3016
Mailing Address - Fax:
Practice Address - Street 1:22512 LOGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-3948
Practice Address - Country:US
Practice Address - Phone:561-674-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15117101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health