MEDICARE: CAROLINA MAGNUSSEN LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	MH18760	FL

General Provider Information

NPI Number	:	1013690296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA MAGNUSSEN LMHC

Provider Business Mailing Address
First Line	:	PO BOX 39601
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33339-9601
Country	:	US
Telephone Number	:	954-802-3327
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 NE 56TH CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-2802
Country	:	US
Telephone Number	:	954-802-3327
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	08/14/2023

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