Healthcare Provider Details

I. General information

NPI: 1619661972
Provider Name (Legal Business Name): CAROLINE FONSECA AGUIAR LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5214F DIAMOND HEIGHTS BLVD # 3422
SAN FRANCISCO CA
94131-2175
US

IV. Provider business mailing address

4524 42ND ST
SUNNYSIDE NY
11104-2957
US

V. Phone/Fax

Practice location:
  • Phone: 415-360-3348
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number016061
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberTPMC8297
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: