=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568771897
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA ANTONELLA CARUSILLO M.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2010
-----------------------------------------------------
Last Update Date | 02/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 E 2ND AVE UNIT 35
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33605-5210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-892-7422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2001 E 2ND AVE UNIT 35
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33605-5210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-892-7422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH13789
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------