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General NPI Number Information
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NPI Number | 1043195142
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Entity Type | Organization
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Legal Business Name | TRYPSTATE LLC
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Dates
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Enumeration Date | 08/07/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 7900 HARBOR ISLAND DR APT 1219
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City | NORTH BAY VILLAGE
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State | FL
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Zip | 33141-4298
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Country | US
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Telephone | 973-951-0923
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Fax |
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Provider Business Mailing Address
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Address Line | 7900 HARBOR ISLAND DR # AT1219
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City | NORTH BAY VILLAGE
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State | FL
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Zip | 33141-4281
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Country | US
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Telephone | 305-204-8338
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. CAROLINA MONTALVO
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Credential | PSYD
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Telephone | 305-204-8338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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