Provider Demographics
NPI:1619230372
Name:MCINTYRE, CAROL CASSANDRA (MSED)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:CASSANDRA
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 SWEETWATER CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2132
Mailing Address - Country:US
Mailing Address - Phone:347-495-6929
Mailing Address - Fax:800-660-2948
Practice Address - Street 1:607 SWEETWATER CLUB CIR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-2132
Practice Address - Country:US
Practice Address - Phone:347-495-6929
Practice Address - Fax:800-660-2948
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346641174400000X
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist