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General NPI Number Information
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NPI Number | 1548513310
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Entity Type | Individual
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Provider Name | JUDA MARIE DECARA MA,NCC,CCMHC
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Gender | Female
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 4690 LIPSCOMB ST SE SUITE 6C
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City | PALM BAY
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State | FL
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Zip | 32905
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Country | US
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Telephone | 813-767-7884
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Fax | 321-574-5417
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Provider Business Mailing Address
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Address Line | 994 SEDGEWOOD CIR
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City | MELBOURNE
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State | FL
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Zip | 32904-8037
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Country | US
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Telephone | 813-767-7884
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Fax | 321-574-5417
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | IMH9063
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH9063
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License Number State | FL
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