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General NPI Number Information
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NPI Number | 1669688065
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Entity Type | Individual
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Provider Name | ROSARIA CARLONE UPCHURCH LMFT
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 721 RIDGEWOOD AVE UNIT #7
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City | HOLLY HILL
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State | FL
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Zip | 32117-3646
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Country | US
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Telephone | 386-252-3414
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Fax | 386-252-3495
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Provider Business Mailing Address
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Address Line | PO BOX 731389
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City | ORMOND BEACH
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State | FL
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Zip | 32173-1389
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Country | US
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Telephone | 386-252-3414
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Fax | 386-252-3495
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT1316
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License Number State | FL
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