Basic Information
Provider Information
NPI: 1063925709
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VIEIRA
FirstName: CAROLINE
MiddleName: DUARTE
NamePrefix:  
NameSuffix:  
Credential: LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4740 N STATE ROAD 7
Address2:  
City: LAUDERDALE LAKES
State: FL
PostalCode: 333195839
CountryCode: US
TelephoneNumber: 9544864005
FaxNumber: 9544973857
Practice Location
Address1: 3050 ZAHARIAS DR
Address2:  
City: ORLANDO
State: FL
PostalCode: 328377024
CountryCode: US
TelephoneNumber: 9549212600
FaxNumber: 9544973857
Other Information
ProviderEnumerationDate: 11/15/2017
LastUpdateDate: 06/08/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/08/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XMH15451FLY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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