1013105329 NPI number — DAVID CARTER, PSY.D., PLLC

Table of content: (NPI 1013105329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013105329 NPI number — DAVID CARTER, PSY.D., PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID CARTER, PSY.D., PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013105329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1133 LOUISIANA AVE
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
WINTER PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32789-2350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1133 LOUISIANA AVE
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
WINTER PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32789-2350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-629-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
OWNER/PSYCHOLOGIST
Authorized Official Telephone Number:
407-629-1000

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PY5836 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 54408 . This is a "BC/BS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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