Provider Demographics
NPI:1760637516
Name:KAMMHOLZ, CAROLYN RUTH
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:RUTH
Last Name:KAMMHOLZ
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 1:1037 PATHFINDER WAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3242
Mailing Address - Country:US
Mailing Address - Phone:321-639-1224
Mailing Address - Fax:
Practice Address - Street 1:1037 PATHFINDER WAY
Practice Address - Street 2:SUITE 130
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3242
Practice Address - Country:US
Practice Address - Phone:321-639-1224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9549101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health