Provider Demographics
NPI:1366627051
Name:CAROL WALTON, PSY.D., P.A.
Entity Type:Organization
Organization Name:CAROL WALTON, PSY.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLWALTON
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-725-9607
Mailing Address - Street 1:2902 BAY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3604
Mailing Address - Country:US
Mailing Address - Phone:321-725-9607
Mailing Address - Fax:321-728-8506
Practice Address - Street 1:1900 S HARBOR CITY BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4749
Practice Address - Country:US
Practice Address - Phone:321-725-9607
Practice Address - Fax:321-728-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-01
Last Update Date:2008-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004344103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty