Provider Demographics
NPI:1528258878
Name:CARABALLO, KARIM (MA)
Entity type:Individual
Prefix:MRS
First Name:KARIM
Middle Name:
Last Name:CARABALLO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR. 312 KM. 1.5 INT. SECTOR LA 15
Mailing Address - Street 2:JARDINES DE MOUNT BLANC CALLE CE-1
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:787-612-6367
Mailing Address - Fax:787-204-8189
Practice Address - Street 1:EDIF CENTRO PLZ E
Practice Address - Street 2:SUITE #201
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4972
Practice Address - Country:US
Practice Address - Phone:787-834-8811
Practice Address - Fax:787-444-1120
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
PR3198103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No171M00000XOther Service ProvidersCase Manager/Care Coordinator