Provider Demographics
NPI:1295594026
Name:CARVALHO, LUIS ANTONIO (C - 5897835)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ANTONIO
Last Name:CARVALHO
Suffix:
Gender:M
Credentials:C - 5897835
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10858 97TH ST
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-4443
Mailing Address - Country:US
Mailing Address - Phone:727-457-8857
Mailing Address - Fax:
Practice Address - Street 1:10858 97TH ST
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-4443
Practice Address - Country:US
Practice Address - Phone:727-457-8857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health