Healthcare Provider Details

I. General information

NPI: 1730373317
Provider Name (Legal Business Name): CARA F O'CONNELL-EDWARDS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 PASEO REYES DR
ST AUGUSTINE FL
32095-8558
US

IV. Provider business mailing address

158 CUMBERLAND ISLAND CIR
PONTE VEDRA FL
32081-0721
US

V. Phone/Fax

Practice location:
  • Phone: 919-699-2077
  • Fax:
Mailing address:
  • Phone: 919-699-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number12218
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3449
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: