Healthcare Provider Details

I. General information

NPI: 1073389813
Provider Name (Legal Business Name): CARLA M BROWN-CAJUSTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W PLYMOUTH AVE
DELAND FL
32720-2753
US

IV. Provider business mailing address

2540 PARTRIDGE DR
WINTER HAVEN FL
33884-3035
US

V. Phone/Fax

Practice location:
  • Phone: 386-873-2963
  • Fax: 386-873-2786
Mailing address:
  • Phone: 863-221-0726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT4042
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: