Healthcare Provider Details

I. General information

NPI: 1265329049
Provider Name (Legal Business Name): CAROLINA MEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8198 S JOG RD STE 201
BOYNTON BEACH FL
33472-6903
US

IV. Provider business mailing address

3520 S OCEAN BLVD APT A103
SOUTH PALM BEACH FL
33480-5747
US

V. Phone/Fax

Practice location:
  • Phone: 561-810-6631
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: