Provider Demographics
NPI:1073702536
Name:CLOYD, CARTER J (PSY D)
Entity Type:Individual
Prefix:DR
First Name:CARTER
Middle Name:J
Last Name:CLOYD
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6032 CHRISTIAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-2314
Mailing Address - Country:US
Mailing Address - Phone:215-990-7714
Mailing Address - Fax:215-748-3442
Practice Address - Street 1:6032 CHRISTIAN ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19143-2314
Practice Address - Country:US
Practice Address - Phone:215-990-7714
Practice Address - Fax:215-748-3442
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00489800103TC0700X
PAPS005965L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101610526 0001Medicaid