Provider Demographics
NPI:1710220405
Name:MOLDON, CAROLINE
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:MOLDON
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 1:14311 SW 96TH ST
Mailing Address - Street 2:302
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1321
Mailing Address - Country:US
Mailing Address - Phone:305-609-7785
Mailing Address - Fax:
Practice Address - Street 1:14311 SW 96TH ST
Practice Address - Street 2:302
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1321
Practice Address - Country:US
Practice Address - Phone:305-609-7785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst