Provider Demographics
NPI:1831960137
Name:DE SEVILLA, CAROLINA MARIA (MS, MED)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:MARIA
Last Name:DE SEVILLA
Suffix:
Gender:F
Credentials:MS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9058
Mailing Address - Country:US
Mailing Address - Phone:419-695-8010
Mailing Address - Fax:606-328-5153
Practice Address - Street 1:8120 GEORGIA ST STE D
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6391
Practice Address - Country:US
Practice Address - Phone:219-756-8201
Practice Address - Fax:260-484-4002
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist