Provider Demographics
NPI:1306036710
Name:CARTER, NANCY J (PSCYH INTERN)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:J
Last Name:CARTER
Suffix:
Gender:F
Credentials:PSCYH INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 SHATTUCK AVE APT A
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1415
Mailing Address - Country:US
Mailing Address - Phone:510-697-0057
Mailing Address - Fax:
Practice Address - Street 1:3195 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2412
Practice Address - Country:US
Practice Address - Phone:510-792-4964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32066103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical