Provider Demographics
NPI:1578028346
Name:CARRASQUILLO, MELISHA (BS)
Entity Type:Individual
Prefix:
First Name:MELISHA
Middle Name:
Last Name:CARRASQUILLO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 CRICKET CLUB CIR APT 304
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-5995
Mailing Address - Country:US
Mailing Address - Phone:787-585-9719
Mailing Address - Fax:
Practice Address - Street 1:1437 CRICKET CLUB CIR APT 304
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-5995
Practice Address - Country:US
Practice Address - Phone:787-585-9719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health