MEDICARE: TRYPSTATE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1043195142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRYPSTATE LLC

Provider Business Mailing Address
First Line	:	7900 HARBOR ISLAND DR # AT1219
Second Line	:
City	:	NORTH BAY VILLAGE
State	:	FL
Zip	:	33141-4281
Country	:	US
Telephone Number	:	305-204-8338
Fax Number	:

Provider Business Practice Location Address
First Line	:	7900 HARBOR ISLAND DR APT 1219
Second Line	:
City	:	NORTH BAY VILLAGE
State	:	FL
Zip	:	33141-4298
Country	:	US
Telephone Number	:	973-951-0923
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. CAROLINA MONTALVO
Credential	:	PSYD
Telephone Number	:	305-204-8338

Provider Enumeration Date	:	08/07/2025
Last Update Date	:	08/07/2025

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Directions to “TRYPSTATE LLC ” Practice Location

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