Provider Demographics
NPI:1154717221
Name:RUMBLE, CAROL (SW6223)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:RUMBLE
Suffix:
Gender:F
Credentials:SW6223
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 OLD MOUNT DORA RD
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-7919
Mailing Address - Country:US
Mailing Address - Phone:305-519-3454
Mailing Address - Fax:
Practice Address - Street 1:357 OLD MOUNT DORA RD
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-7919
Practice Address - Country:US
Practice Address - Phone:305-519-3454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW62231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1041CO700XMedicaid