Provider Demographics
NPI:1477899714
Name:FLEISCHMAN, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:FLEISCHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-6605
Mailing Address - Country:US
Mailing Address - Phone:321-266-5646
Mailing Address - Fax:
Practice Address - Street 1:3060 SUNSET LN
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-6605
Practice Address - Country:US
Practice Address - Phone:321-266-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2024-04-06
Deactivation Date:2019-08-16
Deactivation Code:
Reactivation Date:2019-08-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101YM0800XMedicaid