Provider Demographics
NPI:1073672333
Name:CARTER, DEBRA K (PHD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:CARTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 27TH ST WEST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207
Mailing Address - Country:US
Mailing Address - Phone:941-253-0064
Mailing Address - Fax:941-753-2977
Practice Address - Street 1:4835 27TH ST WEST
Practice Address - Street 2:SUITE 125
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207
Practice Address - Country:US
Practice Address - Phone:941-253-0064
Practice Address - Fax:941-753-2977
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3897103TC0700X, 103TF0000X, 103TH0100X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
U3809ZMedicare ID - Type Unspecified