Healthcare Provider Details

I. General information

NPI: 1649116245
Provider Name (Legal Business Name): MS. KRISTEN RENEE CARPIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 DAIRY RD
WEST MELBOURNE FL
32904-4046
US

IV. Provider business mailing address

5635 S HWY A1A APT 401
MELBOURNE BEACH FL
32951-3336
US

V. Phone/Fax

Practice location:
  • Phone: 321-256-8000
  • Fax:
Mailing address:
  • Phone: 321-256-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: