Provider Demographics
NPI:1831883263
Name:WIEBALK, CAROLINA FERNANDEZ (PSYD)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:FERNANDEZ
Last Name:WIEBALK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2701 SW 3RD AVE APT 503
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-2349
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4835 27TH ST W STE 125
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1759
Practice Address - Country:US
Practice Address - Phone:941-753-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2025-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical