Provider Demographics
NPI:1366332801
Name:ALFONSO, CAROLINA ISABEL (SS)
Entity type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:ISABEL
Last Name:ALFONSO
Suffix:
Gender:F
Credentials:SS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13521 SW MARGO TER
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-5705
Mailing Address - Country:US
Mailing Address - Phone:305-975-3734
Mailing Address - Fax:
Practice Address - Street 1:13521 SW MARGO TER
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-5705
Practice Address - Country:US
Practice Address - Phone:305-975-3734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS749103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool