Active NPI
Carmen Perez-Illade, IMH
- Mental Health Counselor
- Winter Park, FL
National Provider Identifier
1396861829
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH9110
- Practice address
- 2802 Aloma Ave
Suite 102
Winter Park, FL 32792-3532 - Phone
- (407) 430-6300
- Fax
- (407) 628-3300
- NPI assigned
- Mar 22, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MH9110 | FL | Primary |
Addresses
Primary practice location
2802 Aloma Ave
Suite 102
Winter Park, FL 32792-3532
Mailing address
2802 Aloma Ave
Suite 102
Winter Park, FL 32792-3532
Phone (407) 430-6300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11758066 | Other | FL | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH9110 | FL | MD | Mental Health Counselor |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Winter Park, FL
- NPI 1558635805
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184630400000",
"number": "1396861829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2802 ALOMA AVE",
"address_2": "SUITE 102",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327923532",
"telephone_number": "407-430-6300",
"fax_number": "407-628-3300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2802 ALOMA AVE",
"address_2": "SUITE 102",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327923532",
"telephone_number": "407-430-6300",
"fax_number": "407-628-3300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ-ILLADE",
"first_name": "CARMEN",
"credential": "IMH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-22",
"last_updated": "2007-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH9110",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11758066",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winter Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.