MEDICARE: DR. DENISE CARBALLEA PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY12377	FL

General Provider Information

NPI Number	:	1306639398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENISE CARBALLEA PSYD

Provider Business Mailing Address
First Line	:	18115 SW 5TH CT
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-4352
Country	:	US
Telephone Number	:	786-554-9058
Fax Number	:

Provider Business Practice Location Address
First Line	:	18115 SW 5TH CT
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-4352
Country	:	US
Telephone Number	:	786-554-9058
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2025
Last Update Date	:	02/11/2026

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