Provider Demographics
NPI:1689346587
Name:CARASA RODRIGUEZ, MAIDEL
Entity Type:Individual
Prefix:
First Name:MAIDEL
Middle Name:
Last Name:CARASA RODRIGUEZ
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 1:750 NW 43RD AVE APT 608
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3557
Mailing Address - Country:US
Mailing Address - Phone:786-241-2669
Mailing Address - Fax:
Practice Address - Street 1:750 NW 43RD AVE APT 608
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3557
Practice Address - Country:US
Practice Address - Phone:786-241-2669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLC626540808660106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty