Provider Demographics
NPI:1982397022
Name:CARVALLO, MARIA ROSA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ROSA
Last Name:CARVALLO
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 1:13051 SW 242ND ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4127
Mailing Address - Country:US
Mailing Address - Phone:786-862-4769
Mailing Address - Fax:
Practice Address - Street 1:13051 SW 242ND ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:FL
Practice Address - Zip Code:33032-4127
Practice Address - Country:US
Practice Address - Phone:786-862-4769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB911537106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician