Individual
CARLY ATHANASATOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10570 S FEDERAL HWY, SWUITE 200, PORT ST LUCIE, FL 34952-5606
(772) 380-9972
Mailing address
10570 S FEDERAL HWY, SWUITE 200, PORT ST LUCIE, FL 34952-5606
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
FL
222Q00000X
Developmental Therapist
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
Enumeration date
11/17/2014
Last updated
11/17/2014
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