Provider Demographics
NPI:1558996306
Name:CARRIL, MEGAN ELISE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELISE
Last Name:CARRIL
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 1:241 SW 203RD AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5006
Mailing Address - Country:US
Mailing Address - Phone:954-740-3761
Mailing Address - Fax:
Practice Address - Street 1:1495 N PARK DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3215
Practice Address - Country:US
Practice Address - Phone:954-828-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician