MEDICARE: CAROLINA BALDNER

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	101YM0800X	Mental Health Counselor	18121	FL

General Provider Information

NPI Number	:	1356803720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA BALDNER

Provider Business Mailing Address
First Line	:	1098 LAVENDER CIR
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33327-2436
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2731 EXECUTIVE PARK DR STE 4
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33331-3619
Country	:	US
Telephone Number	:	954-553-7262
Fax Number	:

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

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	04/03/2019

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Directions to “ CAROLINA BALDNER ” Practice Location

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