Healthcare Provider Details

I. General information

NPI: 1487103065
Provider Name (Legal Business Name): KARASTAMATIS INSTITUTE FOR CLINICAL HYPNOSIS & HOLISTIC TREATMENTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2016
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14707 S DIXIE HWY SUITE 104
PALMETTO BAY FL
33176-7948
US

IV. Provider business mailing address

14707 S DIXIE HWY SUITE 104
PALMETTO BAY FL
33176-7948
US

V. Phone/Fax

Practice location:
  • Phone: 914-646-4284
  • Fax:
Mailing address:
  • Phone: 914-646-4284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberL29573925
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberL29573952
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberL29573925
License Number StateFL

VIII. Authorized Official

Name: ROBERT ALONSO
Title or Position: OWNER
Credential:
Phone: 305-200-3417