Provider Demographics
NPI:1912396656
Name:CARRASQUILLO, PEDRO J
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:J
Last Name:CARRASQUILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 137901
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34713-7901
Mailing Address - Country:US
Mailing Address - Phone:407-467-5946
Mailing Address - Fax:
Practice Address - Street 1:1050 US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-7520
Practice Address - Country:US
Practice Address - Phone:407-467-5946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health