Provider Demographics
NPI:1720606718
Name:MONTALVO, CAROLINA (PSYD)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 HARBOR ISLAND DR APT 1219
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4298
Mailing Address - Country:US
Mailing Address - Phone:973-951-0923
Mailing Address - Fax:
Practice Address - Street 1:480 NE 30TH ST APT 1606
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4337
Practice Address - Country:US
Practice Address - Phone:973-951-0923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
NY024170-01103TC0700X
FLPY10868103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist