MEDICARE: DR. BETHANIA CARRION PSY.D.

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	PY11164	FL

General Provider Information

NPI Number	:	1891231205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETHANIA CARRION PSY.D.

Provider Business Mailing Address
First Line	:	10257 NW 9TH STREET CIR APT 205
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33172-6603
Country	:	US
Telephone Number	:	786-860-2468
Fax Number	:

Provider Business Practice Location Address
First Line	:	67 NW 183RD ST STE 105
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-4516
Country	:	US
Telephone Number	:	786-860-2468
Fax Number	:

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

Provider Enumeration Date	:	01/09/2017
Last Update Date	:	10/26/2021

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