Provider Demographics
NPI:1528643178
Name:MUNDEN, CAROLINE (LMFT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:MUNDEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 ANTHWYN RD
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2302
Mailing Address - Country:US
Mailing Address - Phone:215-480-0173
Mailing Address - Fax:
Practice Address - Street 1:412 ANTHWYN RD
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2302
Practice Address - Country:US
Practice Address - Phone:215-480-0173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA001016106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA45-4471570Medicaid