Provider Demographics
NPI:1760972012
Name:GARCIA, KAROLINE
Entity Type:Individual
Prefix:MRS
First Name:KAROLINE
Middle Name:
Last Name:GARCIA
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 1:1110 BRICKELL AVE STE 400K-285
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3132
Mailing Address - Country:US
Mailing Address - Phone:305-879-5458
Mailing Address - Fax:
Practice Address - Street 1:1110 BRICKELL AVE STE 400K-285
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-3132
Practice Address - Country:US
Practice Address - Phone:305-879-5458
Practice Address - Fax:305-402-7755
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-40002103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103180400.Medicaid