Provider Demographics
NPI:1750432860
Name:GWALTNEY, CAROL LYNN (LCSW)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LYNN
Last Name:GWALTNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2106 S CYPRESS BEND DR
Mailing Address - Street 2:#509
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-5635
Mailing Address - Country:US
Mailing Address - Phone:954-600-6070
Mailing Address - Fax:954-746-6387
Practice Address - Street 1:7491 W OAKLAND PARK BLVD
Practice Address - Street 2:#308
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-4989
Practice Address - Country:US
Practice Address - Phone:954-746-5667
Practice Address - Fax:954-746-6387
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW69211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical