Provider Demographics
NPI:1083727549
Name:CARLETON, DIANA R (EDD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:R
Last Name:CARLETON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 75TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-1646
Mailing Address - Country:US
Mailing Address - Phone:713-628-6761
Mailing Address - Fax:409-744-0386
Practice Address - Street 1:3316 MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-3829
Practice Address - Country:US
Practice Address - Phone:713-628-6761
Practice Address - Fax:409-744-0386
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3672103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2-3672OtherPSYCHOLOGIST