Provider Demographics
NPI:1861845646
Name:WALDENBURG, CAROL WATSON (LMHC)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:WATSON
Last Name:WALDENBURG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MARTINIQUE CV
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-8063
Mailing Address - Country:US
Mailing Address - Phone:561-625-6052
Mailing Address - Fax:561-625-6992
Practice Address - Street 1:14 MARTINIQUE CV
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-8063
Practice Address - Country:US
Practice Address - Phone:561-625-6052
Practice Address - Fax:561-625-6992
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7183101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health