Provider Demographics
NPI:1700379252
Name:KCC HEALTH CARE
Entity Type:Organization
Organization Name:KCC HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / BCBA
Authorized Official - Prefix:
Authorized Official - First Name:KARELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRALERO CORELLA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:786-663-5171
Mailing Address - Street 1:5273 56TH TER N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2011
Mailing Address - Country:US
Mailing Address - Phone:786-663-5171
Mailing Address - Fax:
Practice Address - Street 1:5273 56TH TER N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2011
Practice Address - Country:US
Practice Address - Phone:786-663-5171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-10
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FLMA60371208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty