Provider Demographics
NPI:1023498615
Name:CASANOVA - GONZALEZ, CARMEN
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:CASANOVA - GONZALEZ
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 1:1000 EMMETT ST STE 102
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-3605
Mailing Address - Country:US
Mailing Address - Phone:787-628-7856
Mailing Address - Fax:
Practice Address - Street 1:1000 EMMETT ST STE 102
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3605
Practice Address - Country:US
Practice Address - Phone:787-627-7856
Practice Address - Fax:497-913-1010
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225400000X
FL33042355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner