Provider Demographics
NPI:1891231205
Name:CARRION, BETHANIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BETHANIA
Middle Name:
Last Name:CARRION
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10257 NW 9TH STREET CIR APT 205
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-6603
Mailing Address - Country:US
Mailing Address - Phone:786-860-2468
Mailing Address - Fax:
Practice Address - Street 1:67 NW 183RD ST STE 105
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4516
Practice Address - Country:US
Practice Address - Phone:786-860-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11164103TC0700X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician