Healthcare Provider Details

I. General information

NPI: 1477899714
Provider Name (Legal Business Name): CARLA FLEISCHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 04/06/2024
Certification Date: 04/06/2024
Deactivation Date: 08/16/2019
Reactivation Date: 08/26/2019

III. Provider practice location address

3060 SUNSET LN
COCOA FL
32922-6605
US

IV. Provider business mailing address

3060 SUNSET LN
COCOA FL
32922-6605
US

V. Phone/Fax

Practice location:
  • Phone: 321-266-5646
  • Fax:
Mailing address:
  • Phone: 321-266-5646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: