Healthcare Provider Details

I. General information

NPI: 1578807186
Provider Name (Legal Business Name): PSYCHOTHERAPY BILINGUAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PLANTATION ISLAND DR S STE 140
ST AUGUSTINE FL
32080-5173
US

IV. Provider business mailing address

PO BOX 3123
ST AUGUSTINE FL
32085-3123
US

V. Phone/Fax

Practice location:
  • Phone: 904-392-5434
  • Fax: 904-471-0074
Mailing address:
  • Phone: 904-392-5434
  • Fax: 888-595-7647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH11064
License Number StateFL

VIII. Authorized Official

Name: DR. BETTY CARVAJAL-PANTALEON
Title or Position: OWNER / MANAGER
Credential: PHD, MS, LMHC
Phone: 904-392-5434