Healthcare Provider Details

I. General information

NPI: 1659616118
Provider Name (Legal Business Name): CARMEN YEBRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5252 SW 139TH PL
MIAMI FL
33175
US

IV. Provider business mailing address

5252 SW 139TH PL
MIAMI FL
33175-5195
US

V. Phone/Fax

Practice location:
  • Phone: 786-319-2980
  • Fax:
Mailing address:
  • Phone: 786-319-2989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-24558
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: