Basic Information
| Provider Information | |||||||||
| NPI: | 1578102497 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CABEZA | ||||||||
| FirstName: | KARIN | ||||||||
| MiddleName: | ALEXANDRA | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 CORPORATE WAY | ||||||||
| Address2: | DOOR D | ||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330253925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542765685 | ||||||||
| FaxNumber: | 9549857074 | ||||||||
| Practice Location | |||||||||
| Address1: | 3600 WASHINGTON ST STE 1005 | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330218216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545185507 | ||||||||
| FaxNumber: | 9545185510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2019 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PY10615 | FL | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.