Physician Compare National (NPI:1770502858)

HEALTHCARE PROVIDER: JOAN ALICE CARRILLO PHD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1770502858
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9537355276
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101122000015
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CARRILLO
	Individual professional last name
Provider First Name	JOAN
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF MISSOURI, COLUMBIA SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1990
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	100 NE15TH ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 208
	Group Practice or individual's line 2 address
City	HOMESTEAD
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	330304576
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3052453900
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y