Individual
BETTY CARVAJAL-PANTALEON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, PHD
Contact information
Practice address
1100 PLANTATION ISLAND DR S, STE 140, ST AUGUSTINE, FL 32080-5173
(904) 392-5434
(904) 471-0074
Mailing address
PO BOX 3123, ST AUGUSTINE, FL 32085-3123
(904) 824-4990
(904) 824-2226
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH11064
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z04JF
NEW DIRECTIONS / FL BLUE
FL
Enumeration date
02/13/2012
Last updated
08/20/2014
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