Healthcare Provider Details

I. General information

NPI: 1639233026
Provider Name (Legal Business Name): CAROLYN MOLDOVANYI LMHC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/11/2024
Certification Date: 08/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 N 10TH ST STE A2
ST AUGUSTINE FL
32084-1872
US

IV. Provider business mailing address

2825 N 10TH ST STE A2
SAINT AUGUSTINE FL
32084-1872
US

V. Phone/Fax

Practice location:
  • Phone: 904-664-1999
  • Fax: 855-486-2788
Mailing address:
  • Phone: 904-664-1999
  • Fax: 855-486-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH6273
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2275
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: