Provider Demographics
NPI:1790409175
Name:CARREIRO, KATHLEEN BARRY (HS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BARRY
Last Name:CARREIRO
Suffix:
Gender:F
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E MERRITT ISLAND CSWY STE 104
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3514
Mailing Address - Country:US
Mailing Address - Phone:321-735-4942
Mailing Address - Fax:321-222-9581
Practice Address - Street 1:800 E MERRITT ISLAND CSWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3542
Practice Address - Country:US
Practice Address - Phone:321-735-4942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHS5672174400000X
FLAS5672237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No174400000XOther Service ProvidersSpecialist