Provider Demographics
NPI:1407390529
Name:CARRASQUILLO-RICHARDSON, NAKISHA MARIE (L P)
Entity Type:Individual
Prefix:DR
First Name:NAKISHA
Middle Name:MARIE
Last Name:CARRASQUILLO-RICHARDSON
Suffix:
Gender:F
Credentials:L P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 PLANTATION ISLAND DR S
Mailing Address - Street 2:STE. 201 A
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-3108
Mailing Address - Country:US
Mailing Address - Phone:904-342-5965
Mailing Address - Fax:
Practice Address - Street 1:1301 PLANTATION ISLAND DR S
Practice Address - Street 2:STE. 201 A
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3108
Practice Address - Country:US
Practice Address - Phone:904-342-5965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9746103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist