Provider Demographics
NPI:1811561822
Name:CAROZZA, MIRNA HIGINIA
Entity Type:Individual
Prefix:
First Name:MIRNA
Middle Name:HIGINIA
Last Name:CAROZZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRNA
Other - Middle Name:HIGINIA
Other - Last Name:CAROZZA CONTRERAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8899 NW 107TH CT UNIT 211
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2181
Mailing Address - Country:US
Mailing Address - Phone:786-817-3962
Mailing Address - Fax:
Practice Address - Street 1:15924 SW 92ND AVE
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1842
Practice Address - Country:US
Practice Address - Phone:305-964-5824
Practice Address - Fax:786-452-1200
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH21085101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health