Healthcare Provider Details

I. General information

NPI: 1053791657
Provider Name (Legal Business Name): CARINA OLTMANN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 MADRUGA AVE STE 313
CORAL GABLES FL
33146-3070
US

IV. Provider business mailing address

721 TIBIDABO AVE
CORAL GABLES FL
33143-6226
US

V. Phone/Fax

Practice location:
  • Phone: 917-613-6650
  • Fax:
Mailing address:
  • Phone: 917-613-6650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW14901
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: