Organization
JOAN ALICE CARRILLO, PH.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOAN ALICE CARRILLO PH.D. (CLINICAL PSYCHOLOGIST)
(305) 666-7055
Entity
Organization
Contact information
Practice address
7901 SW 67TH AVE, 201, SOUTH MIAMI, FL 33143-4538
(305) 666-7055
(786) 349-0144
Mailing address
7901 SW 67TH AVE, 201, SOUTH MIAMI, FL 33143-4538
(305) 666-7055
(786) 349-0144
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
73918
MEDICARE PTAN
FL
Enumeration date
05/12/2016
Last updated
05/12/2016
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