Healthcare Provider Details

I. General information

NPI: 1588917116
Provider Name (Legal Business Name): CASSANDRA ALEXIS CESPEDES CARRASCO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E PRINCETON ST STE 100
ORLANDO FL
32803-1456
US

IV. Provider business mailing address

615 E PRINCETON ST STE 100
ORLANDO FL
32803-1456
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-8877
  • Fax: 407-303-8811
Mailing address:
  • Phone: 407-303-8877
  • Fax: 407-303-8811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPPY267
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY10582
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: