Provider Demographics
NPI:1295853497
Name:MIDDELBERG, CAROL V (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:V
Last Name:MIDDELBERG
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 1:2009 PORT ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7259
Mailing Address - Country:US
Mailing Address - Phone:512-328-9805
Mailing Address - Fax:512-328-9803
Practice Address - Street 1:3660 STONERIDGE RD
Practice Address - Street 2:D102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7760
Practice Address - Country:US
Practice Address - Phone:512-328-9805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23509103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical