Provider Demographics
NPI:1437981784
Name:MCKENZIE-DAVIS, CARON SOPHIA
Entity type:Individual
Prefix:
First Name:CARON
Middle Name:SOPHIA
Last Name:MCKENZIE-DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13750 WEST COLONIAL DRIVE
Mailing Address - Street 2:SUITE 350 236
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787
Mailing Address - Country:US
Mailing Address - Phone:813-304-4126
Mailing Address - Fax:
Practice Address - Street 1:414 LAKE HOWELL RD
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5900
Practice Address - Country:US
Practice Address - Phone:407-637-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker