Basic Information
Provider Information
NPI: 1679719355
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CARRION
FirstName: MILAGROS
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: MSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 18017 CADENCE ST
Address2:  
City: ORLANDO
State: FL
PostalCode: 328202729
CountryCode: US
TelephoneNumber: 4074926700
FaxNumber:  
Practice Location
Address1: 2479 ALOMA AVE
Address2:  
City: WINTER PARK
State: FL
PostalCode: 327922541
CountryCode: US
TelephoneNumber: 4076576692
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/30/2008
LastUpdateDate: 12/30/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X  Y Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


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