Basic Information
| Provider Information | |||||||||
| NPI: | 1861167736 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARROUSEL THERAPY CENTER CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2822 FORSYTH RD STE 201C | ||||||||
| Address2: | |||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327926684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079102941 | ||||||||
| FaxNumber: | 8884477678 | ||||||||
| Practice Location | |||||||||
| Address1: | 2822 FORSYTH RD STE 201C | ||||||||
| Address2: | |||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327926684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079102941 | ||||||||
| FaxNumber: | 8884477678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2021 | ||||||||
| LastUpdateDate: | 08/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | RIVERA | ||||||||
| AuthorizedOfficialFirstName: | DALIS | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4078913054 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator | 2084P0800X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.