Provider Demographics
NPI:1508360827
Name:CARLO, GEOFFRY (LMFT)
Entity Type:Individual
Prefix:
First Name:GEOFFRY
Middle Name:
Last Name:CARLO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 TERRAPIN LN APT 122
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3107
Mailing Address - Country:US
Mailing Address - Phone:954-242-9773
Mailing Address - Fax:
Practice Address - Street 1:3750 TERRAPIN LN APT 122
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3107
Practice Address - Country:US
Practice Address - Phone:954-242-9773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YA0400X
FLMT3156106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)