Provider Demographics
NPI:1770079154
Name:CARSWELL, AMESHA SYNORA (CAP)
Entity type:Individual
Prefix:MRS
First Name:AMESHA
Middle Name:SYNORA
Last Name:CARSWELL
Suffix:
Gender:F
Credentials:CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 BITTERBERRY DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-5245
Mailing Address - Country:US
Mailing Address - Phone:440-265-8146
Mailing Address - Fax:
Practice Address - Street 1:1459 BITTERBERRY DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-5245
Practice Address - Country:US
Practice Address - Phone:440-265-8146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP0100429101YA0400X
101YM0800X
OH163065101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health