MEDICARE: DR. CAROL MESSMORE LMFT

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	106H00000X	Marriage & Family Therapist	MT1860	FL

General Provider Information

NPI Number	:	1467593483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL MESSMORE LMFT

Provider Business Mailing Address
First Line	:	1611 NE 2ND AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-4107
Country	:	US
Telephone Number	:	561-843-1058
Fax Number	:	561-243-1828

Provider Business Practice Location Address
First Line	:	75 NE 6TH AVE
Second Line	:	SUITE 218-B
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5435
Country	:	US
Telephone Number	:	561-843-1058
Fax Number	:	561-243-1828

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2007
Last Update Date	:	07/08/2007

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